Abstract
Six Sigma: Decreasing neonatal intraventricular hemorrhage by delayed umbilical cord clamping
Highlights
The total number of intraventricular hemorrhage (IVH) decreased from 6/71 IVHs per year (2014) prior to initiation of delayed cord clamping and NICU bundles to 1/42 IVHs in the new process
Using the average number of days of stay of 63 days for a Grade III and IV hemorrhages at our institution, and, a cost of $850/day, we had a decrease in hospital NICU costs for IVH with delayed cord clamping of $267,750 [$321,300 (6X$850X63)$53,550 (1X63X$850)] and saved 315 NICU bed days
These cost savings do not include the substantial costs for the substantial morbidity with Grade III and IV due to increased rates of CP, learning disabilities, blindness, and deafness
Summary
The purpose of this research was to evaluate the impact of applying Six-Sigma methodology, the Define-Measure-AnalyzeImprove-Control (DMAIC) and Lean tools to decrease the rate of intraventricular Grade III and Grade IV hemorrhage in preterm neonates ≤32 weeks. Our program involved introduction of delayed cord clamping of 30 seconds at delivery and care bundles in the neonatal intensive care unit to decrease IVH. Our institution is the largest hospital in West Virginia. Our institution is a non-profit, academic, regional tertiary referral center. The hospital system performs 37,454 inpatient discharges and 530,861 out-patient visits annually. Our system is the largest provider of uncompensated care in West Virginia and the largest Medicaid provider in West Virginia. Obstetrical/ gynecologic, neurology, orthopedic, urologic, trauma, general surgical, cardiothoracic, and neonatology services.
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