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Quality improvement sustainability to decrease utilization drift for therapeutic hypothermia in the NICU

  • Hannah Kieffer , Katherine Carlton , Samuel Adams , Jenna Jozwik , Erwin Cabacungan und Susan S. Cohen ORCID logo EMAIL logo
Veröffentlicht/Copyright: 29. März 2023
Journal of Perinatal Medicine
Aus der Zeitschrift Journal of Perinatal Medicine Band 51 Heft 7

Abstract

Objectives

Therapeutic hypothermia (TH) is now standard of care for the neuroprotection of patients with moderate to severe hypoxic-ischemic encephalopathy (HIE). TH misuse results in increased medical complication rates and high health care resource utilization. Quality improvement (QI) methodology can address drift from clinical guidelines. Assessment of sustainability of any intervention over time is an integral part of the QI methodology.

Methods

Our prior QI intervention improved medical documentation using an electronic medical record-smart phrase (EMR-SP) and demonstrated special cause variation. This study serves as Epoch 3 and investigates the sustainability of our QI methods to decrease TH misuse.

Results

A total of 64 patients met the diagnostic criteria for HIE. Over the study period, 50 patients were treated with TH, and 33 cases (66%) used TH appropriately. The number of appropriate TH cases between cases of misuse increased to an average of 9 in Epoch 3 from 1.9 in Epoch 2. Of the 50 cases, 34 (68%) had EMR-SP documentation included. Length of stay and TH complication rates did not vary between cases of TH misuse and appropriate TH use.

Conclusions

Our study confirmed a sustained decrease in TH misuse, despite inconsistent use of EMR-SP. We speculate that culture change involving increased awareness of guidelines through education may have contributed more to a lasting change.

Keywords: hypoxic-ischemic encephalopathy; quality improvement; therapeutic hypothermia; utilization drift
Corresponding author: Susan S. Cohen, MD Associate Professor, Division of Neonatology, Children’s Corporate Center, 999 N. 92nd Street Suite C410, Milwaukee, WI, 53226, USA, Phone: 414-955-2375, Fax: 414-266-6979, E-mail:

Acknowledgments

We would like to thank the Department of Pediatrics, Medical College of Wisconsin (MCW) and the MCW Medical Student Summer Research Program (MSSRP) for supporting this research.

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Conflicts of interests: Authors state no conflict of interest.

  4. Informed consent: Not applicable.

  5. Ethical approval: Approval was granted through Children’s Wisconsin Institutional Review Board with waiver of informed consent.

References

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/jpm-2022-0421).

Received: 2022-08-28
Accepted: 2023-03-04
Published Online: 2023-03-29
Published in Print: 2023-09-26

© 2023 Walter de Gruyter GmbH, Berlin/Boston

Artikel in diesem Heft

  1. Frontmatter
  2. Reviews
  3. Covid-19 vaccination and pregnancy: a systematic review of maternal and neonatal outcomes
  4. Improvised bubble continuous positive airway pressure ventilation use in neonates in resource-limited settings: a systematic review and meta-analysis
  5. Opinion Papers
  6. Anger: an underappreciated destructive force in healthcare
  7. Severe maternal thrombocytopenia and prenatal invasive procedures: still a grey zone
  8. Commentary
  9. The care of the magic of life before and after its beginning
  10. Original Articles – Obstetrics
  11. The impact of trimester of COVID-19 infection on pregnancy outcomes after recovery
  12. Adverse outcomes and maternal complications in pregnant women with severe-critical COVID-19: a tertiary center experience
  13. Are bacteria, fungi, and archaea present in the midtrimester amniotic fluid?
  14. Bioavailability of the tumor necrosis factor alpha/regulated on activation, normal T cell expressed and secreted (RANTES) biosystem inside the gestational sac during the pre-immune stages of embryo development
  15. The role of the soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PIGF) – ratio in clinical practice in obstetrics: diagnostic and prognostic value
  16. Prenatal diagnosis of non-mosaic sex chromosome abnormalities: a 10-year experience from a tertiary referral center
  17. Prediction of lung maturity through quantitative ultrasound analysis of fetal lung texture in women with diabetes during pregnancy
  18. Evaluation of an artificial intelligent algorithm (Heartassist™) to automatically assess the quality of second trimester cardiac views: a prospective study
  19. Original Article – Fetus
  20. Fetal brain activity and the free energy principle
  21. Predictive value of ultrasound in prenatal diagnosis of hypospadias: hints for accurate diagnosis
  22. The effect of maternal diabetes on the expression of gamma-aminobutyric acid and metabotropic glutamate receptors in male newborn rats’ inferior colliculi
  23. Original Articles – Neonates
  24. Respiratory function monitoring during early resuscitation and prediction of outcomes in prematurely born infants
  25. Quality improvement sustainability to decrease utilization drift for therapeutic hypothermia in the NICU
  26. Short Communication
  27. Use of a pocket-device point-of-care ultrasound to assess cervical dilation in labor: correlation and patient experience
  28. Letters to the Editor
  29. Correspondence on “COVID-19 vaccination and pregnancy”
  30. Response to the letter to the editor regarding “Covid-19 vaccination and pregnancy: a systematic review of maternal and neonatal outcomes”
https://doi.org/10.1515/jpm-2022-0421
Schlagwörter für diesen Artikel
hypoxic-ischemic encephalopathy; quality improvement; therapeutic hypothermia; utilization drift

Artikel in diesem Heft

  1. Frontmatter
  2. Reviews
  3. Covid-19 vaccination and pregnancy: a systematic review of maternal and neonatal outcomes
  4. Improvised bubble continuous positive airway pressure ventilation use in neonates in resource-limited settings: a systematic review and meta-analysis
  5. Opinion Papers
  6. Anger: an underappreciated destructive force in healthcare
  7. Severe maternal thrombocytopenia and prenatal invasive procedures: still a grey zone
  8. Commentary
  9. The care of the magic of life before and after its beginning
  10. Original Articles – Obstetrics
  11. The impact of trimester of COVID-19 infection on pregnancy outcomes after recovery
  12. Adverse outcomes and maternal complications in pregnant women with severe-critical COVID-19: a tertiary center experience
  13. Are bacteria, fungi, and archaea present in the midtrimester amniotic fluid?
  14. Bioavailability of the tumor necrosis factor alpha/regulated on activation, normal T cell expressed and secreted (RANTES) biosystem inside the gestational sac during the pre-immune stages of embryo development
  15. The role of the soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PIGF) – ratio in clinical practice in obstetrics: diagnostic and prognostic value
  16. Prenatal diagnosis of non-mosaic sex chromosome abnormalities: a 10-year experience from a tertiary referral center
  17. Prediction of lung maturity through quantitative ultrasound analysis of fetal lung texture in women with diabetes during pregnancy
  18. Evaluation of an artificial intelligent algorithm (Heartassist™) to automatically assess the quality of second trimester cardiac views: a prospective study
  19. Original Article – Fetus
  20. Fetal brain activity and the free energy principle
  21. Predictive value of ultrasound in prenatal diagnosis of hypospadias: hints for accurate diagnosis
  22. The effect of maternal diabetes on the expression of gamma-aminobutyric acid and metabotropic glutamate receptors in male newborn rats’ inferior colliculi
  23. Original Articles – Neonates
  24. Respiratory function monitoring during early resuscitation and prediction of outcomes in prematurely born infants
  25. Quality improvement sustainability to decrease utilization drift for therapeutic hypothermia in the NICU
  26. Short Communication
  27. Use of a pocket-device point-of-care ultrasound to assess cervical dilation in labor: correlation and patient experience
  28. Letters to the Editor
  29. Correspondence on “COVID-19 vaccination and pregnancy”
  30. Response to the letter to the editor regarding “Covid-19 vaccination and pregnancy: a systematic review of maternal and neonatal outcomes”
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