Amy T Nathan1,2, Laura Ward3,4, Kurt Schibler3,4, Laurel Moyer3,4,5, Andrew South3,4,6, Heather C Kaplan3,4. 1. Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA. Amy.Nathan@cchmc.org. 2. Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Amy.Nathan@cchmc.org. 3. Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA. 4. Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 5. Rady Children's Hospital, San Diego, CA, USA. 6. Akron Children's Hospital, Akron, OH, USA.
Abstract
OBJECTIVE: Necrotizing enterocolitis (NEC) is a devastating intestinal disease in premature infants. Local rates of NEC were unacceptably high. We hypothesized that utilizing quality improvement methodology to standardize care and apply evidence-based practices would reduce our rate of NEC. STUDY DESIGN: A multidisciplinary team used the model for improvement to prioritize interventions. Three neonatal intensive care units (NICUs) developed a standardized feeding protocol for very low birth weight (VLBW) infants, and employed strategies to increase the use of human milk, maximize intestinal perfusion, and promote a healthy microbiome. RESULTS: The primary outcome measure, NEC in VLBW infants, decreased from 0.17 cases/100 VLBW patient days to 0.029, an 83% reduction, while the compliance with a standardized feeding protocol improved. CONCLUSION: Through reliable implementation of evidence-based practices, this project reduced the regional rate of NEC by 83%. A key outcome and primary driver of success was standardization across multiple NICUs, resulting in consistent application of best practices and reduction in variation.
OBJECTIVE:Necrotizing enterocolitis (NEC) is a devastating intestinal disease in premature infants. Local rates of NEC were unacceptably high. We hypothesized that utilizing quality improvement methodology to standardize care and apply evidence-based practices would reduce our rate of NEC. STUDY DESIGN: A multidisciplinary team used the model for improvement to prioritize interventions. Three neonatal intensive care units (NICUs) developed a standardized feeding protocol for very low birth weight (VLBW) infants, and employed strategies to increase the use of human milk, maximize intestinal perfusion, and promote a healthy microbiome. RESULTS: The primary outcome measure, NEC in VLBW infants, decreased from 0.17 cases/100 VLBW patient days to 0.029, an 83% reduction, while the compliance with a standardized feeding protocol improved. CONCLUSION: Through reliable implementation of evidence-based practices, this project reduced the regional rate of NEC by 83%. A key outcome and primary driver of success was standardization across multiple NICUs, resulting in consistent application of best practices and reduction in variation.
Authors: Gregory P Goldstein; Vidya V Pai; Jessica Liu; Krista Sigurdson; Lelis B Vernon; Henry C Lee; Karl G Sylvester; Gary M Shaw; Jochen Profit Journal: Pediatr Res Date: 2020-08 Impact factor: 3.756