Quality Program Improved Outcomes in Neonatal ICUs

Dr Prakesh S Shah MSc, MBBS, MD, DCH, MRCP, FRCPC Professor, Departments of Paediatrics and HPME Mount Sinai Hospital and University of Toronto CIHR Applied Research Chair in Reproductive and Child Health Services and Policy Research Director, Canadian Neonatal Network Toronto Ontario Canada M5G 1X5MedicalResearch.com Interview with:
Dr Prakesh S Shah MSc, MBBS, MD, DCH, MRCP, FRCPC
Professor, Departments of Paediatrics and HPME
Mount Sinai Hospital and University of Toronto
CIHR Applied Research Chair in Reproductive and Child Health Services and Policy Research
Director, Canadian Neonatal Network
Toronto Ontario Canada M5G 1X5

Medical Research: What are the main findings of the study?

Dr. Shah: The main findings of our study are that by embracing collaborative quality improvement program in 25 of 28 Neonatal ICUs in the country, we were able to show significant reduction in adverse outcomes of necrotizing enterocolitis, severe retinopathy of prematurity and nosocomial infections among preterm neonates born at less than 29 weeks of gestation. This resulted in significant overall reduction of composite outcome of mortality or severe morbidities and improved overall outcomes over 3 years of study period.

Medical Research: Were any of the findings unexpected?

Dr. Shah: Quality improvement efforts in neonatal ICUs have shown variable results with most of them targeting one or two outcomes and some have shown improvement and others have shown no change. Unexpected findings from our study were that the degree of reduction in adverse outcome was significant and important in multiple outcomes domains. Additionally, we were surprised to see such degree of improvement despite an increase in number of extremely immature (<25 weeks gestation) neonates.

Medical Research: What should clinicians and patients take away from your report?

Dr. Shah: Clinicians should realize that quality improvement efforts take some time before results are realized and embracing the complete concept by immersive involvement in such efforts over along run will pay of in true improvement. Patients, in our context parents of the fragile neonates, should realize that all units are constantly striving to improve quality of care delivered to their newborn and results are encouraging.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Shah:

  • First, we need to continue quality improvement efforts as it is well-known that at the end of such process the result return back to where they were if sustained efforts are not ongoing.
  • Second, future efforts should involve multidisciplinary involvement and not limited to physicians or nurses only.
  • Finally, we recommend that such quality improvement efforts should integrate component of “learning from each other” and visits to different units with an idea to learn and teach would benefit all involved parties.

Citation:

Association of a quality improvement program with neonatal outcomes in extremely preterm infants: a prospective cohort study
Shoo K. Lee, Prakesh S. Shah, Nalini Singhal, Khalid Aziz, Anne Synnes, Douglas McMillan, Mary M. Seshia, and for the Canadian EPIQ Study Group

 

CMAJ cmaj.140399; published ahead of print August 18, 2014, doi:10.1503/cmaj.140399