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A multidisciplinary quality improvement effort to reduce bronchopulmonary dysplasia incidence.

ABSTRACT: BACKGROUND:Bronchopulmonary Dysplasia (BPD) is the most common prematurity complication. Although several practices have been proposed for BPD prevention, none of these in isolation prevent BPD. METHODS:Our initiative focused on two key drivers: oxygen management and noninvasive ventilation strategies. We created best practice guidelines and followed outcome measures using Shewhart control charts. RESULTS:PDSAs of protocols preceded a large-scale rollout of a "0.21 by 28" campaign in 2014 leading to a special cause reduction in the "any BPD" rate, and a decrease in severe BPD (from 57 to 29%). At the end of 2017, we reinvigorated the project, which led to dramatic decreases in the "any BPD" rate to 41% and the "severe BPD" rate to 21%. CONCLUSIONS:A multidisciplinary QI initiative focused on process improvement geared towards the pathophysiological contributors of BPD has successfully reduced the rate of BPD in an all referral level IV NICU.

SUBMITTER: Bapat R

PROVIDER: S-EPMC7223819 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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A multidisciplinary quality improvement effort to reduce bronchopulmonary dysplasia incidence.

Bapat Roopali R Nelin Leif L Shepherd Edward E Ryshen Greg G Elgin Amee A Bartman Thomas T

Journal of perinatology : official journal of the California Perinatal Association 20200106 4

<h4>Background</h4>Bronchopulmonary Dysplasia (BPD) is the most common prematurity complication. Although several practices have been proposed for BPD prevention, none of these in isolation prevent BPD.<h4>Methods</h4>Our initiative focused on two key drivers: oxygen management and noninvasive ventilation strategies. We created best practice guidelines and followed outcome measures using Shewhart control charts.<h4>Results</h4>PDSAs of protocols preceded a large-scale rollout of a "0.21 by 28" c ...[more]

PMID: 31907398

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Project description:The objective of this study was to investigate whether a respiratory care bundle, implemented through participation in the Vermont Oxford Network-sponsored Neonatal Intensive Care Quality Improvement Collaborative (NIC/Q 2005) and primarily dependent on bedside caregivers, resulted in sustained decrease in the incidence of bronchopulmonary dysplasia (BPD) in infants < 30 wk gestation.A retrospective cohort study was conducted. Infants inborn between 23 wk and 29 wk + 6 d of gestation were included. Patients with congenital heart disease, significant congenital or lung anomalies, or death before intubation were excluded. Four time periods (T1-T4) were identified: T1: September 1, 2002 to August 31, 2004; T2: September 1, 2004 to August 31, 2006; T3: September 1, 2006 to August 31, 2008; T4: September 1, 2008 to August 31, 2010.A total of 1,050 infants were included in the study. BPD decreased significantly in T3 post-implementation of the respiratory bundle compared with T1 (29.9% vs 51.2%, respectively; adjusted odds ratio [aOR] = 0.06 [95% CI 0.03-0.13], P = < .001). The decrease was not sustained into T4. There was a significant increase in the rate of BPD-free survival to discharge in T3 compared with T1 (53.1% vs 47%; aOR = 1.68 [95% CI 1.11-2.56], P = .01) that was also not sustained. The rate of infants requiring O2 at 28 d of life decreased significantly in T3 versus T1 (40.3% vs 69.9%, respectively; aOR = 0.12 [95% CI 0.07-0.20], P = < .001). Increases in the rate of surfactant administration by 1 h of life and rate of caffeine use were observed in T4 versus T1, respectively. There was a significant decrease in median ventilator days and a significant increase in the median number of noninvasive CPAP days throughout the study period.In this study, implementation of a respiratory bundle managed primarily by nurses and respiratory therapists was successful in increasing the use of less invasive respiratory support in a consistent manner among very low birthweight infants at a single institution. However, this study and others have failed to show sustained improvement in the incidence of BPD despite sustained process change.

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A multidisciplinary quality improvement effort to reduce bronchopulmonary dysplasia incidence.

Publications

A multidisciplinary quality improvement effort to reduce bronchopulmonary dysplasia incidence.

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