Neonatal Intensive Care Unit, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
Evaluation, South West Academic Health Science Network, Exeter, Devon, UK.
BMJ Open Qual. 2022 Aug;11(3). doi: 10.1136/bmjoq-2022-001904.
Perinatal Excellence to Reduce Injury in Premature Birth (PERIPrem) is an 11-element perinatal care bundle designed to improve outcomes for preterm babies, in line with the National Health Service (NHS) Long Term plan. Designed in collaboration with 12 NHS Trusts (secondary care hospitals), South West and West of England Academic Health Science Networks, South West Neonatal Operational Delivery Network, parent partners and clinical experts, implementation was via bespoke quality improvement (QI) methodology. Before project initiation, there was regional variation in uptake of elements, evidenced by baseline audit. Optimisation of the preterm infant is complex; eligibility for treatments is dependent on gestation and local policies. Preterm infants experience variability in care dependent on the place of birth, and there remains an implementation gap for several effective, evidence-based treatments.The PERIPrem ambition is to reduce severe brain injury and death caused by prematurity by at least 50% through the delivery of a perinatal care bundle. The PERIPrem approach resulted in improved element implementation by 26% (from 3% to 29%) between 2019 and 2021, with dyads significantly more likely to receive the full bundle in 2021 compared with 2019 (probability=0.96 (95% CI 0.87 to 0.99), p<0.001). When examining the impact on psychological safety and team-working of PERIPrem, linear mixed models indicated an improvement in team function (p=0.021), situation monitoring (p=0.029) and communication within teams (p=0.002). Central to success was the development of a committed multiorganisational collaborative that continues to drive perinatal improvement using a common language and streamlining processes. In addition to saving the lives of the most vulnerable babies, PERIPrem aims to improve the chances of disability-free lives and is successfully nurturing high-functioning perinatal teams with enhanced QI skills.
围产卓越以减少早产损伤（PERIPrem）是一个 11 要素的围产护理包，旨在改善早产儿的结局，符合国民保健制度（NHS）长期计划。该护理包由 12 家 NHS 信托基金（二级保健医院）、英格兰西南部和西部学术卫生网络、西南新生儿运营交付网络、家长合作伙伴和临床专家合作设计，通过定制的质量改进（QI）方法实施。在项目启动之前，由于基线审计，元素的采用存在区域差异。优化早产儿的情况很复杂；治疗的资格取决于胎龄和当地政策。早产儿的护理取决于出生地点，存在几个有效、有证据支持的治疗方法的实施差距。PERIPrem 的目标是通过提供围产护理包，将因早产导致的严重脑损伤和死亡至少减少 50%。PERIPrem 方法使元素的实施率在 2019 年至 2021 年间提高了 26%（从 3%提高到 29%），并且在 2021 年与 2019 年相比，双胞胎接受完整护理包的可能性显著增加（概率=0.96（95%CI 0.87-0.99），p<0.001）。当检查 PERIPrem 对心理安全和团队合作的影响时，线性混合模型表明团队功能（p=0.021）、情况监测（p=0.029）和团队内部沟通（p=0.002）有所改善。成功的关键是发展一个有承诺的多组织合作，继续使用共同的语言和简化流程来推动围产期的改进。PERIPrem 不仅旨在拯救最脆弱的婴儿的生命，还旨在提高无残疾生活的机会，并成功培养具有增强 QI 技能的高效围产团队。
