Faculty Collaboration Database

Quality improvement sustainability to decrease utilization drift for therapeutic hypothermia in the NICU. J Perinat Med 2023 Sep 26;51(7):956-961

Date

03/29/2023

Pubmed ID

36976872

DOI

10.1515/jpm-2022-0421

Scopus ID

2-s2.0-85151362983 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

OBJECTIVES: Therapeutic hypothermia (TH) is now standard of care for the neuroprotection of patients with moderate to severe hypoxic-ischemic encephalopathy (HIE). TH misuse results in increased medical complication rates and high health care resource utilization. Quality improvement (QI) methodology can address drift from clinical guidelines. Assessment of sustainability of any intervention over time is an integral part of the QI methodology.

METHODS: Our prior QI intervention improved medical documentation using an electronic medical record-smart phrase (EMR-SP) and demonstrated special cause variation. This study serves as Epoch 3 and investigates the sustainability of our QI methods to decrease TH misuse.

RESULTS: A total of 64 patients met the diagnostic criteria for HIE. Over the study period, 50 patients were treated with TH, and 33 cases (66%) used TH appropriately. The number of appropriate TH cases between cases of misuse increased to an average of 9 in Epoch 3 from 1.9 in Epoch 2. Of the 50 cases, 34 (68%) had EMR-SP documentation included. Length of stay and TH complication rates did not vary between cases of TH misuse and appropriate TH use.

CONCLUSIONS: Our study confirmed a sustained decrease in TH misuse, despite inconsistent use of EMR-SP. We speculate that culture change involving increased awareness of guidelines through education may have contributed more to a lasting change.

Author List

Kieffer H, Carlton K, Adams S, Jozwik J, Cabacungan E, Cohen SS

Authors

Samuel J. Adams MD Assistant Professor in the Neurology department at Medical College of Wisconsin
Erwin Cabacungan MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Katherine Carlton MD Assistant Professor in the Pediatrics department at Medical College of Wisconsin
Susan Cohen MD Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Humans
Hypothermia, Induced
Hypoxia-Ischemia, Brain
Infant, Newborn
Intensive Care Units, Neonatal
Patient Acceptance of Health Care
Quality Improvement