"Quality improvement initiatives in neonatal intensive  care unit (NICU) for improved care outcomes- a  review of evidence"

El-Atawi, Khaled; Elhalik, Mahmoud; Dash, Swarup Kumar

doi:10.15406/jpnc.2019.09.00366

Cited by 9 publications

(6 citation statements)

References 54 publications

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“…One such example is prevention of cardiovascular complications, specifically cardiac arrest with cardiopulmonary resuscitation. However, neonatal QI interventions currently exist for prevention of CNS, pulmonary, and systemic infectious complications with institutions having successfully implemented initiatives aimed at decreasing neonatal intraventricular hemorrhage, central line associated blood stream infections, unplanned extubation, and ventilator associated pneumonia 26–33. As such, complications like these potentially represent the most feasible targets for neonatal QI interventions focused on complication prevention.…”

Section: Discussionmentioning

confidence: 99%

Variation in Complications and Mortality According to Infant Diagnosis

et al. 2022

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Objective: Investigate patterns of infant perioperative mortality, describe the infant diagnoses with the highest mortality burden, and evaluate the association between types of postoperative complications and mortality in infants. Background: The majority of mortality events in pediatric surgery occur among infants (ie, children <1 y old). However, there is limited data characterizing patterns of infant perioperative mortality and diagnoses that account for the highest proportion of mortality. Methods: Infants who received inpatient surgery were identified in the National Surgical Quality Improvement Program-Pediatric database (2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019). Perioperative mortality was stratified into mortality associated with a complication or mortality without a complication. Complications were categorized as wound infection, systemic infection, pulmonary, central nervous system, renal, or cardiovascular. Multivariable logistic regression was used to evaluate the association between different complications and complicated mortality. Results: Among 111,946 infants, the rate of complications and perioperative mortality was 10.4% and 1.6%, respectively. Mortality associated with a complication accounted for 38.8% of all perioperative mortality. Seven diagnoses accounted for the highest proportion of mortality events (40.3%): necrotizing enterocolitis (22.3%); congenital diaphragmatic hernia (7.3%); meconium peritonitis (3.8%); premature intestinal perforation (2.5%); tracheoesophageal fistula (1.8%); gastroschisis (1.4%); and volvulus (1.1%). Relative to wound complications, cardiovascular [odds ratio (OR): 19.4, 95% confidence interval (95% CI): 13.9-27.0], renal (OR: 6.88; 4.65-10.2), and central nervous system complications (OR: 6.50; 4.50-9.40) had the highest odds of mortality for all infants. Conclusions: A small subset of diagnoses account for 40% of all infant mortality and specific types of complications are associated with mortality. These data suggest targeted quality improvement initiatives could be implemented to reduce adverse surgical outcomes in infants.

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Section: Discussionmentioning

confidence: 99%

Variation in Complications and Mortality According to Infant Diagnosis

et al. 2022

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“…[ 24 25 ] Taking proper and correct actions prevent these problems in the two areas of structure, process, and promote quality of care. [ 26 ]…”

Section: Introductionmentioning

confidence: 99%

Developing patient safety standards for health-care quality promotion in neonatal intensive care units

Shahkolahi

Irajpour

Jafari-Mianaei

et al. 2022

Journal of Education and Health Promotion

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BACKGROUND: Neonatal intensive care unit (NICU) is one of the accident-prone settings in the health-care system. There is a series of structural and process threats to the safety of infants hospitalized in this unit, which can be prevented by taking the right actions. For this purpose, developing standards based on current knowledge, available resources, and the context that provides care can determine patient injury prevention requirements. Likewise, it can be a source for national development and application of related guidelines and protocols. This study aims to develop patient safety standards in the NICUs of Iran. MATERIALS AND METHODS: This mixed-methods study will apply the exploration, preparation, implementation, and sustainment framework to develop patient safety standards. In each phase of this framework, a set of activities take place. Exploration is based on the world health organization model to develop standards. Determining the validity and applicability of standards will be done in Phase 2 (Preparation) and Phase 3 (Implementation), respectively. Since the long-term effects are not desired, the fourth phase (Sustainment) will not be considered. DISCUSSION: Patient safety standards from this study will contribute to efficient and effective, equitable, and high-quality health-care delivery. The application of them will further promote patient safety and the quality of medical care in Iranian NICUs.

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“…10 11 Quality improvement (QI) has improved the central line care practices and brought about a reduction in LONS and CLABSIs, thereby improving the quality of healthcare in NICUs of developed nations. [12][13][14][15][16] Studies from LMIC settings, including India, are few and vary widely due to diverse contextual settings. [17][18][19][20][21] The Point Of Care Quality Improvement (POCQI) methodology developed by WHO has been used in several maternal and neonatal health settings in LMIC settings.…”

Section: Introductionmentioning

confidence: 99%

Reducing late-onset neonatal sepsis in very low birthweight neonates with central lines in a low-and-middle-income country setting

2021

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BackgroundLate-onset neonatal sepsis (LONS) is a significant contributor to morbidity and mortality in very low birthweight (VLBW) neonates with indwelling central lines. Compliance to central line care bundles is suboptimal in low-and-middle-income country settings. Point of care quality improvement (POCQI) method may be used to improve the compliance gap. We used the POCQI method to achieve an improvement in compliance to central line care bundles with an aim to reduce LONS in a subset of VLBW neonates.MethodsA pre and post-intervention study consisting of three phases was conducted in a tertiary care neonatal intensive care unit. A root-cause analysis was undertaken to find the causes of LONS in VLBW babies with central lines. Multiple change ideas were identified and tested using sequential Plan-Do-Study-Act (PDSA) cycles to address the issue of reduced compliance to the central line care bundles. The change ideas tested in PDSA cycles which were successful were adopted. Compliance to the insertion and maintenance bundles was measured as process indicators. LONS, central line associated bloodstream infections and all-cause mortality rates were measured as outcome indicators.ResultsA total of 10 PDSA cycles testing multiple change ideas (staff education, audio-visual aids, supply issues) were undertaken during the study duration. Bundles were not being used in the study setting prior to the initiation of the study. Insertion bundle compliance was above 90% and maintenance bundle compliance increased from 23.3% to 42.2% during the intervention and sustenance phases, respectively. A 43.3% statistically significant reduction in LONS rates was achieved at the end of the study. No effect on mortality was seen.ConclusionPOCQI method can be used to improve compliance to central line care bundles which can lead to a reduction of LONS in VLBW neonates with central lines in situ.

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"Quality improvement initiatives in neonatal intensive care unit (NICU) for improved care outcomes- a review of evidence"

Cited by 9 publications

References 54 publications

Variation in Complications and Mortality According to Infant Diagnosis

Variation in Complications and Mortality According to Infant Diagnosis

Developing patient safety standards for health-care quality promotion in neonatal intensive care units

Reducing late-onset neonatal sepsis in very low birthweight neonates with central lines in a low-and-middle-income country setting

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