Improving Time to Goals of Care Discussions in Invasively Ventilated Preterm Infants

Area of Science:

• Neonatal Medicine
• Pediatric Pulmonology
• Quality Improvement Science

Background:

• Identifying preterm infants with bronchopulmonary dysplasia (BPD) needing tracheostomy can delay goals of care (GOC) discussions.
• Early identification of infants unlikely to be liberated from ventilation can facilitate timely GOC discussions and reduce tracheostomy dependence.

Purpose of the Study:

• To reduce the postmenstrual age (PMA) of GOC discussions by 20% in infants with BPD and prolonged invasive ventilatory support.
• To improve the timeliness of care planning for ventilator-dependent infants.

Main Methods:

• A quality improvement initiative was conducted at the University of Alabama at Birmingham.
• Infants born <32 weeks' gestation requiring invasive ventilation ≥2 weeks beyond 36 weeks' PMA were included.
• Interventions included consensus identification of at-risk infants, monthly multidisciplinary tracheostomy meetings, and family education.

Main Results:

• Analysis included 79 infants; 44 received tracheostomy or died.
• Time to GOC discussions decreased from 62 to 51 weeks' PMA, linked to multidisciplinary conferences.
• Average PMA at tracheostomy decreased from 80 to 63 weeks, with no change in tracheostomy frequency or discordant GOC discussions.

Conclusions:

• Standardizing GOC discussions in ventilator-dependent BPD infants reduced the PMA for both GOC discussions and tracheostomy placement.
• This quality improvement initiative demonstrated successful early intervention in care planning.