title: Sequential analysis for quality control in the neonatal intensive care unit.
abstract: OBJECTIVE
  This article describes a novel application of a statistical technique for continuous quality assurance in the NICU.
  
  
  METHODS
  We used prospective analysis of rates of survival to 28 days of life, without major IVH in ELBW infants in a single tertiary NICU, before and after the introduction of an evidence-based treatment protocol. By using the CUSUM function, each infant's results were sequentially plotted, and significant changes in outcomes were noted when the plot crossed predetermined boundary lines.
  
  
  RESULTS
  Significant changes in outcomes were evident with this method sooner than traditional analyses on the basis of year-end or other arbitrary intervals. The introduction of the ELBW protocol was temporally associated with significant improvement in intact short-term survival.
  
  
  CONCLUSIONS
  Sequential analysis techniques are useful tools for ongoing quality assurance; deviations in outcomes may be detected more quickly, which should assist in the identification of improvements or decrements in performance of the NICU.
authors.affiliation: Department of Pediatrics, the University of California-San Diego, CA, USA.
authors.forename: K J
authors.initials: KJ
authors.lastname: Barrington
authors.forename: J
authors.initials: J
authors.lastname: Denson-Lino
authors.forename: R
authors.initials: R
authors.lastname: Bloch
authors.forename: N N
authors.initials: NN
authors.lastname: Finer
mesh_terms: D003627:Data Interpretation, Statistical; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000592:standards* / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data*; D011786:Quality Control; D012307:Risk Factors; D015996:Survival Rate