Ellsbury Dan L, Clark Reese H, Ursprung Robert, Handler Darren L, Dodd Elizabeth D, Spitzer Alan R
The Center for Research, Education and Quality, Pediatrix Medical Group, Sunrise, Florida
The Center for Research, Education and Quality, Pediatrix Medical Group, Sunrise, Florida.
Pediatrics. 2016 Apr;137(4). doi: 10.1542/peds.2015-0389. Epub 2016 Mar 2.
Despite advances in neonatal medicine, infants requiring neonatal intensive care continue to experience substantial morbidity and mortality. The purpose of this initiative was to generate large-scale simultaneous improvements in multiple domains of care in a large neonatal network through a program called the "100,000 Babies Campaign."
Key drivers of neonatal morbidity and mortality were identified. A system for retrospective morbidity and mortality review was used to identify problem areas for project prioritization. NICU system analysis and staff surveys were used to facilitate reengineering of NICU systems in 5 key driver areas. Electronic health record-based automated data collection and reporting were used. A quality improvement infrastructure using the Kotter organizational change model was developed to support the program.
From 2007 to 2013, data on 422 877 infants, including a subset with birth weight of 501 to 1500 g (n = 58 555) were analyzed. Key driver processes (human milk feeding, medication use, ventilator days, admission temperature) all improved (P < .0001). Mortality, necrotizing enterocolitis, retinopathy of prematurity, bacteremia after 3 days of life, and catheter-associated infection decreased. Survival without significant morbidity (necrotizing enterocolitis, severe intraventricular hemorrhage, severe retinopathy of prematurity, oxygen use at 36 weeks' gestation) improved.
Implementation of a multifaceted quality improvement program that incorporated organizational change theory and automated electronic health record-based data collection and reporting program resulted in major simultaneous improvements in key neonatal processes and outcomes.
尽管新生儿医学取得了进展，但需要新生儿重症监护的婴儿仍面临着较高的发病率和死亡率。本倡议的目的是通过一项名为“十万婴儿运动”的计划，在一个大型新生儿网络的多个护理领域实现大规模的同步改善。
确定了新生儿发病率和死亡率的关键驱动因素。使用回顾性发病率和死亡率审查系统来确定项目优先级的问题领域。通过新生儿重症监护病房（NICU）系统分析和员工调查，对五个关键驱动因素领域的NICU系统进行重新设计。采用基于电子健康记录的自动数据收集和报告。开发了一个使用科特组织变革模型的质量改进基础设施来支持该计划。
分析了2007年至2013年期间422877例婴儿的数据，其中包括出生体重为501至1500克的子集（n = 58555）。关键驱动流程（母乳喂养、药物使用、机械通气天数、入院体温）均有所改善（P < .0001）。死亡率、坏死性小肠结肠炎、早产儿视网膜病变、出生后3天的菌血症以及导管相关感染均有所下降。无严重发病率（坏死性小肠结肠炎、重度脑室内出血、重度早产儿视网膜病变、孕36周时吸氧）的生存率有所提高。
实施一项多方面的质量改进计划，该计划纳入组织变革理论以及基于电子健康记录的自动数据收集和报告程序，导致关键新生儿流程和结局同时得到重大改善。
