Background: Advances in perinatal care have led to a significant reduction in morbidity and mortality among very-low-birth-weight (VLBW) infants. Much of this progress is related to the prevention and management of respiratory disease. Objectives: To evaluate changes in perinatal care and its influence on respiratory morbidity and mortality among VLBW infants in Spain in 2 consecutive periods (2002-2006 and 2007-2011). Methods: This is a retrospective analysis of data prospectively collected of all VLBW infants included in the Spanish SEN1500 network. Patients with major congenital anomalies, those who died in the delivery room (DR) and infants <230 or >346 weeks of gestational age (GA) were excluded. Results: During the study period, out of 27,205 eligible VLBW infants, 24,598 (90.4%) met inclusion criteria. The most striking and statistically significant results found in the second period were: (i) reduction in the proportion of “outborn” patients; (ii) an increase in prenatal steroid administration; (iii) enhanced non-invasive respiratory support in the DR and NICU; (iv) reduction in invasive mechanical ventilation, surfactant administration, and steroids for bronchopulmonary dysplasia (BPD). Moreover, survival to hospital discharge increased (83.5 vs. 84.7%; p = 0.015); however, survival without BPD increased only among the most immature (230 to 266 weeks' GA) from 26.6 to 31.6% (p < 0.001). Conclusions: Enhanced adherence to international recommendations in perinatal care and a significant reduction in mortality were found during the second period. Survival without BPD increased only among the most immature. Further investigation is needed to optimize the strategies to prevent and manage respiratory disease in this group of patients.
There is a lack of consensus on quality indicators suitable for neonatal transport. The aim of this study is to make a proposal for specific quality indicators for newborn transport. A retrospective descriptive study was performed (2009 to 2015) where twenty-four indicators were selected, evaluated and classified according to the 6 dimensions of quality of the Institute of Medicine. Among the 24 evaluated quality metrics, there were 3 of them which needed a correction when evaluating neonatal transport performance, because they were significantly correlated with gestational age. They were (a) stabilisation time, (b) prevalence of newborn arterial hypotension (defined by gestational age) and (c) unnoticed hypothermia at referral hospital. Conclusion: Quality evaluation through the definition of specific metrics in newborn transport is feasible. These indicators should be defined or adjusted for newborn population to measure the actual performance of the transport service. What is Known: • Quality indicators may help in defining metrics for clinical practice, promoting benchmarking and defining areas of improvement. • Newborn characteristics call for a specialised care, and quality measure during newborn transport require specific metrics. Quality metrics for paediatric transport have been defined using Delphi method. Some of these measures need to be specific for newborn, due to their intrinsic characteristics. What is New: • Using evidence-based literature and our newborn transport experience, specific quality indicators for newborn transport are suggested. • Data analysis shows how some indicators need to be adjusted for gestational age.
Background and Purpose: As a National effort to provide a framework to improve stroke best practices, a multi- center healthcare system with 48 hospitals across ten states established a stroke collaborative working group. The purpose was to develop a forum to standardize and improve stroke evidenced-based best practices with sister facilities. Methods: A questionnaire was developed and distributed to the stroke collaborative group. A telephone conference was held to review survey results and organizational trends from the 2010 Get With The Guidelines (GWTG) stroke quality metrics. Three quality metrics, dysphagia screening, patient education and door to needle (DTN) were initially identified along with establishing three subcommittees to focus upon improving best practices for each of these measures. Educational webinars, best practice successes and barriers were shared on monthly conference calls as well as a development of an email stroke distribution list serve to improve communication. Results: The three chosen GWTG stroke quality metric score aggregates from 2010 to 2013 second quarter were: dysphagia screen 78.8% to 85.7%, patient education 86% to 94.6%, DTN 60 minutes or less 31% to 72.8% with a mean DTN time of 91 minutes to 68.8 minutes. Conclusion: Formation of a stroke collaborative group for this organization had a positive effect on improving stroke best practices. Areas of focus identified were standardized best practice processes which included creation of system-wide electronic stroke order sets, development of staff and patient educational materials, implementation of templates and development of a DTN challenge. As the Stroke Collaborative expanded three additional working subcommittees were established, Patient Satisfaction, Emergency Medical Service collaboration and Stroke Support Group Development. In conclusion facilitation of communication and collaboration utilizing individual talents and resources is an effective way to improve stroke evidenced-based best practice across a multi-state healthcare system.
The results provided a common set of indicators to evaluate the coordination and continuity of care for cancer screening and to consequently assess the contribution of nursing care in cancer screening programs. The identification and adaptation of these quality indicators will help to identify areas for improvement and measure the effect of coordination and continuity of care.
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