Standardizing neonatal hypoxic ischemic encephalopathy evaluation and documentation practices.

Area of Science:

• Neonatal Neurology
• Pediatric Critical Care
• Clinical Quality Improvement

Background:

• Infants at risk for hypoxic ischemic encephalopathy (HIE) require urgent evaluation for therapeutic hypothermia (TH).
• A lack of standardized local evaluation protocols previously hindered timely HIE assessment and treatment decisions.

Purpose of the Study:

• To develop and implement a standardized pathway for evaluating infants at risk of HIE.
• To improve the timeliness and completeness of therapeutic hypothermia (TH) eligibility assessments within the critical first six hours of life.

Main Methods:

• Infants meeting specific HIE risk criteria (patient characteristics and biochemical markers) were included.
• The primary outcome measured was the documentation of a complete HIE therapeutic hypothermia evaluation (HIETHE) within six hours of birth.
• Plan-Do-Study-Act cycles and clinical decision support tools were utilized to standardize the evaluation process.

Main Results:

• The documented percentage of infants at risk for HIE receiving a complete HIETHE significantly improved.
• Documentation rates increased from 47% to 82% between October 2020 and May 2023.

Conclusions:

• A standardized approach effectively streamlined the evaluation process for infants at risk of HIE.
• The implementation led to a significant improvement in the rate of complete and timely TH eligibility evaluations.