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Quality Improvement Initiative Enhances Outpatient Pediatric Pulmonology Follow-up for Premature Infants with
Eliaz Brumer1, Sanjiv Godse1, Leela Chandrasekar1
1From the Department of Pediatrics, Section of Respiratory, Allergy-Immunology, and Sleep Medicine, Yale University, New Haven, Conn.
Insights
A quality improvement project enhanced care for premature infants with bronchopulmonary dysplasia (BPD). The initiative improved diagnosis accuracy and increased outpatient pulmonary follow-up appointment attendance to over 85%.
Area of Science:
- Pediatrics
- Pulmonology
- Quality Improvement Science
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease common in premature infants, leading to increased hospital readmissions due to respiratory issues.
- Effective management of BPD requires accurate diagnosis, severity classification, and consistent outpatient pulmonary follow-up.
Purpose of the Study:
- To improve the accuracy of BPD diagnosis and severity classification.
- To increase the rate of outpatient pulmonary follow-up appointment scheduling and attendance for premature infants with moderate to severe BPD to over 85% within six months.
Main Methods:
- A quality improvement project was implemented at Yale New Haven Children's Hospital.
- Key interventions included developing an electronic medical record-integrated BPD clinical pathway for standardized diagnosis, classification (ICD-10 code P27.1), and treatment.
- Outcome measures focused on correct BPD diagnosis, timely appointment scheduling (within 45 days), and appointment attendance.
Main Results:
- Correct BPD diagnosis rates increased from 49% to 95%.
- The percentage of patients scheduled for pulmonology appointments rose from 71.9% to 100%.
- Appointment attendance increased from 55.6% to 87.1%.
Conclusions:
- The quality improvement initiative successfully enhanced the accuracy of BPD diagnosis and severity classification.
- The project significantly improved outpatient pulmonary follow-up rates for children with moderate and severe BPD.
Introduction:
Bronchopulmonary dysplasia (BPD) is a chronic lung disorder affecting many premature infants. Infants with BPD have higher hospital readmission rates due to respiratory-related morbidity. We aimed to increase the rates of outpatient pulmonary follow-up and attendance of premature babies with moderate and severe BPD to above 85% within 6 months.
Methods:
We conducted a quality improvement project at Yale New Haven Children's Hospital. Key interventions included developing a BPD clinical pathway integrated into the electronic medical record to assist providers in correctly classifying BPD severity, assigning the appropriate International Classification of Diseases, 10th Revision code (P27.1), and providing standardized treatment options. The outcome measures included correct diagnosis and classification of BPD, the percentage of patients with BPD scheduled for pediatric pulmonology appointments within 45 days, and the percentage attending those appointments.
Results:
There were 226 patients in our study, including 85 in the baseline period. Correct diagnosis of BPD increased from 49% to 95%, the percentage of scheduled appointments increased from 71.9% to 100%, and the percentage of appointments attended increased from 55.6% to 87.1%.
Conclusions:
Our quality improvement initiative improved the accuracy of diagnosis, severity classification, and outpatient pulmonary follow-up of children with moderate and severe BPD.
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