Redpath Stephanie, Moore Heather, Sucha Ewa, Agarwal Amisha, Barrowman Nicholas, Lemyre Brigitte, St Germain Louise
Department of Pediatrics, Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, ON, Canada.
Transport Team, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
Pediatr Qual Saf. 2022 Jun 14;7(3):e556. doi: 10.1097/pq9.0000000000000556. eCollection 2022 May-Jun.
Therapeutic hypothermia (TH) within 6 hours after birth is known to improve both survival and neurodevelopmental outcomes in neonates with hypoxic ischemic encephalopathy (HIE). Meeting this recommended target temperature for neonates who require transport for TH treatment can be complex for various reasons. This study aimed to reduce the time from birth to the initiation of TH and target temperature, thereby increasing the proportion of transported neonates reaching target temperature within 6 hours to >50%.
We evaluated the effect of three quality improvement interventions, including revised transport team processes, outreach education/resources, and the use of a servo-controlled cooling device on land transports. We compared key outcome TH metrics for cohorts before and after implementation.
The study team compared baseline data for 77 to 102 neonates born between 2009 and April 2015 (preintervention) and September 2015 and September 2020 (postintervention(s)). We observed reductions in both the time from birth to the initiation of passive cooling (38%) and time to reach target TH temperature (23%), with an increase in the proportion of neonates reaching target temperature by 6 hours of age from 50% to 71%.
We used quality improvement methodology to identify key areas for intervention(s) and improvement. Targeted interventions have successfully and consistently improved the timing and delivery of TH to neonates with hypoxic ischemic encephalopathy within the transport environment, with a 20% increase in neonates reaching target temperature by 6 hours of age.
已知出生后6小时内进行治疗性低温（TH）可改善缺氧缺血性脑病（HIE）新生儿的生存率和神经发育结局。由于各种原因，对于需要转运以接受TH治疗的新生儿而言，达到这一推荐的目标温度可能很复杂。本研究旨在缩短从出生到开始TH治疗及达到目标温度的时间，从而使在6小时内达到目标温度的转运新生儿比例提高至50%以上。
我们评估了三项质量改进干预措施的效果，包括修订转运团队流程、开展外展教育/提供资源以及在陆地转运中使用伺服控制冷却设备。我们比较了实施干预措施前后队列的关键TH指标。
研究团队比较了2009年至2015年4月（干预前）以及2015年9月至2020年9月（干预后）出生的77至102例新生儿的基线数据。我们观察到从出生到开始被动冷却的时间减少了38%，达到目标TH温度的时间减少了23%，6小时龄时达到目标温度的新生儿比例从50%增至71%。
我们采用质量改进方法来确定干预和改进的关键领域。针对性干预措施已成功且持续改善了在转运环境中对缺氧缺血性脑病新生儿进行TH治疗的时机和效果，6小时龄时达到目标温度的新生儿比例提高了20%。
