109. USING QI METHODOLOGY TO DECREASE UTILIZATION DRIFT OF THERAPEUTIC HYPOTHERMIA

Abstract

Background The use of therapeutic hypothermia (TH) is neuroprotective in patients with moderate or severe hypoxic ischemic encephalopathy (HIE). We previously identified drift away from the standard of care guideline leading to the overuse of TH. This utilization drift has been attributed to gaps in medical documentation and lack of guideline awareness. Aim Statement Our aim was to increase the number of appropriate TH cases between each misuse TH case by December 2018. Interventions We conducted a QI project in our level IV NICU. A multidisciplinary QI team was formed including physicians, nurses, and ancillary providers. The patient population included all infants who received TH from 1/1/16 to 1/10/20. We developed a key driver diagram to determine the interventions to target which included EMR smartphrase implementation, provider education, and data sharing. Measures Our outcome measure was the number of appropriate TH cases between each misuse TH case. Our process measure was the percent of cases with complete documentation of the modified Sarnat score. Balancing measures were the number of cases where TH was underutilized and hospital length of stay. A geometric means chart (G chart) was created to analyze our outcome measure given that the time between each HIE case is rare. Results Special cause improvement was achieved in the number of appropriate TH cases between each misuse TH case after the 3 interventions were performed. Following implementation of EMR smartphrases, there was an improvement in overall modified Sarnat score documentation. Currently the EMR smartphrase is used in 76% of cases. Balancing measures remain unchanged. Conclusions and Next Steps Following interventions of EMR smartphrase implementation, education, and data sharing there was an increase in the number of appropriate TH cases between each misuse TH case. Next steps of enacting EMR Best Practice Alerts may help further increase appropriate TH use for patients with HIE.