Scott Emily K, Downs Stephen M, Pottenger Amy K, Bien James P, Saysana Michele S
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Ind.
Stanford Cancer Institute, Stanford University School of Medicine, Stanford, Calif.
Pediatr Qual Saf. 2020 Jun 26;5(4):e327. doi: 10.1097/pq9.0000000000000327. eCollection 2020 Jul-Aug.
Approximately, 3,500 infants die annually from sleep-related infant deaths in the United States. We sought to improve pediatricians' counseling on safe sleep from birth through 6 months of age through a virtual quality improvement learning collaborative (QILC). Our aim was appropriate screening, counseling, and documentation of safe sleep advice in 75% of eligible patient encounters after the QILC.
We formed a 9-month QILC for inpatient and outpatient pediatricians. Pediatricians collected data on safe sleep documentation in a newborn discharge or well-child visit note. Data were submitted at baseline and in 9 subsequent phases. Participants met monthly via a webinar, which included a QI presentation, data review, and facilitated discussion among participants. Practices were contacted 12 months after the conclusion of the QILC to assess sustainment.
Thirty-four pediatricians from 4 inpatient and 9 outpatient practices participated in the QILC. At baseline, documentation of safe sleep practices varied greatly (0%-98%). However, by the end of the QILC, all participating practices were documenting safe sleep guidance in over 75% of patient encounters. Aggregate practice data show a significant, sustained improvement. The 12-month follow-up data were submitted from 62% of practices, with sustainment of improvement in 75% of practices.
A facilitated, virtual QILC is an effective methodology to improve safe sleep counseling among a diverse group of pediatric practices. It is one step in improving consistent messaging around safe sleep by healthcare providers as pediatricians work to decrease sleep-related infant deaths.
在美国,每年约有3500名婴儿死于与睡眠相关的婴儿死亡事件。我们试图通过虚拟质量改进学习协作组织(QILC)来改善儿科医生对从出生到6个月大婴儿安全睡眠的咨询服务。我们的目标是在QILC之后,在75%符合条件的患者诊疗中进行适当的筛查、咨询和记录安全睡眠建议。
我们为住院和门诊儿科医生组建了一个为期9个月的QILC。儿科医生在新生儿出院记录或健康儿童就诊记录中收集有关安全睡眠记录的数据。数据在基线时以及随后的9个阶段提交。参与者每月通过网络研讨会会面,其中包括质量改进报告、数据审查以及参与者之间的促进性讨论。在QILC结束12个月后联系各医疗机构以评估持续性。
来自4家住院医疗机构和9家门诊医疗机构的34名儿科医生参与了QILC。在基线时,安全睡眠做法的记录差异很大(0%-98%)。然而,到QILC结束时,所有参与的医疗机构在超过75%的患者诊疗中记录了安全睡眠指导。总体实践数据显示有显著的、持续的改善。62%的医疗机构提交了12个月的随访数据,75%的医疗机构维持了改善。
一个有促进作用的虚拟QILC是一种有效的方法,可以改善不同儿科医疗机构之间的安全睡眠咨询。这是儿科医生努力减少与睡眠相关的婴儿死亡时,改善医疗服务提供者围绕安全睡眠的一致信息传递的重要一步。