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Standardizing neonatal hypoxic ischemic encephalopathy evaluation and documentation practices
Patrick J Peebles1, Lori Christ2,3, John Flibotte2,3
1Division of Neonatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. pjpeebles@wisc.edu.
Insights
A standardized evaluation for infants at risk of hypoxic ischemic encephalopathy (HIE) was implemented. This improved timely therapeutic hypothermia (TH) eligibility assessments, increasing documentation from 47% to 82%.
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.
Background:
Infants at risk for hypoxic ischemic encephalopathy (HIE) require a time sensitive evaluation and decision-making regarding treatment with therapeutic hypothermia (TH). Prior to this project, there was no standardized approach to evaluating these infants locally.
Methods:
Included infants were "at risk for HIE," defined as meeting the "patient characteristics" and "biochemical criteria" per the institutional HIE pathway. Our primary outcome was documentation of an HIE therapeutic hypothermia evaluation (HIETHE) within the first six hours of life which included: (1) recognition of at-risk status, (2) an encephalopathy exam, and (3) a decision regarding TH. Plan-Do-Study-Act cycles included novel clinical decision support.
Results:
From October 2020 to May 2023, among infants at-risk for HIE, the average percentage with an HIETHE documented improved from 47% to 82%.
Conclusions:
We standardized the approach to infants at risk for HIE and improved the presence of a complete and timely evaluation regarding TH eligibility.
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