Quality improvement for NICU graduates: Feasible, relevant, impactful

Jonathan S Litt; Susan R Hintz

doi:10.1016/j.siny.2021.101205

Quality improvement for NICU graduates: Feasible, relevant, impactful

Semin Fetal Neonatal Med. 2021 Feb;26(1):101205. doi: 10.1016/j.siny.2021.101205. Epub 2021 Feb 8.

Authors

Jonathan S Litt¹, Susan R Hintz²

Affiliations

¹ Department of Neonatology, Beth Israel Deaconess Medical Center Boston, 330 Brookline Avenue, Rose 3, 02215, Boston, MA, USA; Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA. Electronic address: jlitt@bidmc.harvard.edu.
² Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford School of Medicine, 750 Welch Road, Suite 315, Palo Alto, 94034, Stanford, CA, USA; California Perinatal Quality Care Collaborative-California Children's Services High Risk Infant Follow-Up Quality of Care Initiative, San Francisco, CA, USA. Electronic address: srhintz@stanford.edu.

PMID: 33589361
DOI: 10.1016/j.siny.2021.101205

Abstract

Continuous quality improvement (CQI) has become a vital component of newborn medicine. Applying core principles - robust measurement, repeated small tests of change, collaborative learning through data sharing - have led to improvements in care quality, safety, and outcomes in the Neonatal Intensive Care Unit (NICU). High-risk infant follow-up programs (HRIF) have historically aided such quality improvement efforts by providing outcomes data about NICU interventions. Though as a discipline, HRIF has not universally embraced CQI for its own practice. In this review, we summarize the history of CQI in neonatology and applications of improvement science in healthcare and describe examples of CQI in HRIF. We identify the need for consensus on what defines 'high-risk' and constitutes meaningful outcomes. Last, we outline four areas for future investment: establishing evidence-based care delivery systems, standardizing outcomes and their measures, embracing a family-centered approach prioritizing parent goals, and developing professional standards of care for HRIF.

Keywords: Extremely low birth weight; High risk infant follow-up; Program evaluation; Quality improvement infant; Very low birth weight infant.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Review

MeSH terms

Humans
Infant
Infant, Newborn
Intensive Care Units, Neonatal*
Neonatology*
Parents
Quality Improvement
Quality of Health Care