Quality Improvement/Patient Safety: Subspecialty-specific QI: see specialties above
QI 3: Subspecialty-specific QI & Patient Safety
Allie Baldwin, DO
Resident Physician
Texas Tech University Health Sciences Center School of Medicine
Lubbock, Texas, United States
Measure and demonstrate a significant improvement of ELBW infant morbidities using the LBK guidelines, implemented in multiple stages.
Design/Methods:
The LBK QI initiative started in April of 2019 by establishing standard practice guidelines for the management of infants born less than 29 weeks of gestation and/or with a birthweight (BW) less than 1,000 grams. Implementation was divided into three stages; (1) focused on the first 24 hours of life (HOL), (2) 24 HOL to 7 days of life (DOL), and (3) 7 DOL to discharge home. The LBK guidelines focused on delivery room resuscitation, the golden hour, medications, ventilator and respiratory management, and a feeding protocol. A pre-implementation cohort of similar BW and gestational age (GA) infants were used as a baseline. A p value of < 0.05 was considered significant for statistical analysis.
Results:
GA, BW, APGAR scores, and prenatal complications were similar between pre (PRE) and post (POST) implementation groups. Growth parameters including weight, length, and head circumference at DOL 7, 14, 28, and discharge were similar between groups. The POST group spent less days intubated on the high frequency oscillator and/or ventilator and more days on nasal ventilation compared to PRE. The PRE group had a higher percentage of infants requiring oxygen at 36 weeks corrected GA compared to the POST group (83% vs. 56%). Chronic Lung Disease (CLD) severity was lower in the POST group. The POST group required less days on TPN (13.9 days) vs. the PRE group (25.7 days). The POST group reached full feeds earlier in life (16.6 days) vs. 22.6 days in the PRE group. Antibiotic days were reduced in the POST group compared to the PRE group (11 days vs. 19 days). IVH and NEC were comparable in each group.
Conclusion(s): The LBK guidelines have demonstrated a substantial reduction in CLD rates and improved nutritional outcomes in our population. This supports historical trends of improved ELBW morbidities using PDC. Continued application of the LBK guidelines in additional hospital settings should be studied to ensure generalizability.