Department of Pediatrics, Stanford University, Stanford, California;
California Perinatal Quality Care Collaborative, Stanford, California.
Pediatrics. 2018 Jul;142(1). doi: 10.1542/peds.2017-1395. Epub 2018 Jun 13.
There is unexplained variation in length of stay (LOS) across NICUs, suggesting that there may be practices that can optimize LOS.
Three groups of NICUs in the California Perinatal Quality Care Collaborative were followed: (1) collaborative centers participating in an 18-month collaborative quality improvement project to optimize LOS for preterm infants; (2) individual centers aiming to optimize LOS; and (3) nonparticipants. Our aim in the collaborative project was to decrease postmenstrual age (PMA) at discharge for infants born between 27 + 0 and <32 weeks' gestational age by 3 days. A secondary outcome was "early discharge," the proportion of infants discharged from the hospital before 36 + 5 weeks' PMA. The balancing measure of readmissions within 72 hours was tracked for the collaborative group.
From 2013 to 2015, 8917 infants were cared for in 20 collaborative NICUs, 19 individual project NICUs, and 71 nonparticipants. In the collaborative group, the PMA at discharge decreased from 37.8 to 37.5 weeks ( = .02), and early discharge increased from 31.6% to 41.9% ( = .006). The individual project group had no significant change. Nonparticipants had a decrease in PMA from 37.5 to 37.3 weeks ( = .01) but no significant change in early discharge (39.8% to 43.6%; = .24). There was no significant change in readmissions over time in the collaborative group.
A structured collaborative project that was focused on optimizing LOS led to a 3-day decrease in LOS and was more effective than individualized quality improvement efforts.
新生儿重症监护病房（NICU）的住院时间（LOS）存在无法解释的差异，这表明可能存在可以优化 LOS 的实践。
加利福尼亚围产期质量改进合作组织中的三组 NICU 进行了以下研究：（1）参与为期 18 个月的合作质量改进项目以优化早产儿 LOS 的协作中心；（2）旨在优化 LOS 的单个中心；（3）非参与者。我们在合作项目中的目标是将 27+0 至<32 周胎龄出生婴儿的出院时校正胎龄（PMA）减少 3 天。次要结果是“提前出院”，即 PMA 在 36+5 周前出院的婴儿比例。协作组还跟踪了 72 小时内再入院的平衡措施。
2013 年至 2015 年，20 家协作 NICU、19 家个体项目 NICU 和 71 家非参与者共收治了 8917 名婴儿。在协作组中，出院时的 PMA 从 37.8 周降至 37.5 周（=0.02），提前出院率从 31.6%增至 41.9%（=0.006）。个体项目组无显著变化。非参与者的 PMA 从 37.5 周降至 37.3 周（=0.01），但提前出院率无显著变化（从 39.8%增至 43.6%；=0.24）。协作组的再入院率在整个研究期间没有显著变化。
一项以优化 LOS 为重点的结构化合作项目使 LOS 减少了 3 天，比个体化质量改进措施更有效。
