Collaborative Quality Improvement for Neonatal Intensive Care. † 1026

Abstract

We evaluated the effects of collaborative quality improvement and benchmarking on two specific neonatal outcomes in a study of 10 neonatal intensive care units (NICUs) in the Vermont Oxford Network. Multidisciplinary teams of neonatologists, nurses, quality coaches and administrators from the 10 NICUs worked closely together in facilitated large group meetings and conference calls beginning in January 1995. They chose specific clinical improvement goals, performed analyses of their care processes, evaluated the published evidence and performed site visits to project NICUs and others in the Network with superior performance. Reducing nosocomial infection for infants 501 to 1500 grams was the goal chosen by 6 NICUs; reducing chronic lung disease or death for infants 501 to 1000 grams was chosen by the other group of 4 NICUs. The groups developed lists of “potentially better practices” and each NICU implemented selected practices by the beginning of 1996. Outcomes were monitored with the Network Database. The project was evaluated by comparing outcomes in 1994 (pre-intervention) to those in 1996(post-intervention) and by comparing changes in outcomes at the project NICUs with those at the other 66 North American NICUs participating in the Vermont Oxford Network from 1994 to 1996. The rate of infection with coagulase negative Staphylococcus (cnS) decreased at the 6 infection group NICUs from 22.0% to 16.6% (p=0.007); infections with other pathogens did not change significantly. The 5.4% decline in cnS at the 6 NICUs was greater than the 0.8% decline seen at the 66 comparison NICUs (p=0.026). At the 4 NICUs in the chronic lung disease group, the percentage of infants receiving supplemental oxygen at 36 weeks post-conceptional age decreased from 43.5% to 31.5%(p=0.03); mortality did not change significantly. The 12% decline in oxygen at 36 weeks at the 4 NICUs was greater than the 0.1% decline seen at the 66 comparison NICUs (p=0.045). The magnitude of improvement in both cnS infection and oxygen at 36 weeks varied significantly among the NICUs. We conclude that collaborative quality improvement has the potential to improve the outcomes of neonatal intensive care.