title: Clinical process improvement: reduction of pneumothorax and mortality in high-risk preterm infants.
abstract: OBJECTIVE
  To develop multidisciplinary clinical process improvement methods using evidence-based medicine to decrease the incidence of pneumothorax in a NICU.
  
  
  METHODS
  All inborn infants <28 weeks' gestation (n=79) served as the historical baseline group. A prospective protocol, using evidence-based medicine and a rapid-cycle, multidisciplinary clinical process improvement method, was designed to measure changes in the incidence of pneumothorax in subsequent infants of similar gestational ages.
  
  
  RESULTS
  Sixty consecutive inborn infants <28 weeks' gestational age comprised the study group. In comparison to the historical control group, there was a significant reduction in the incidence of pneumothorax (from 26.6% to 10%, p=0.018) and in mortality (36.7% to 15%, p=0.007) without adversely affecting any other measured outcome variable.
  
  
  CONCLUSIONS
  Introduction of multidisciplinary clinical process improvement methods can significantly decrease the incidence of adverse outcomes in neonatal intensive care units.
authors.affiliation: The Children's Hospital, Greenville Hospital System, Greenville, SC 29605, USA.
authors.forename: M Whit
authors.initials: MW
authors.lastname: Walker
authors.forename: Mike
authors.initials: M
authors.lastname: Shoemaker
authors.forename: Kim
authors.initials: K
authors.lastname: Riddle
authors.forename: Martin M
authors.initials: MM
authors.lastname: Crane
authors.forename: Reese
authors.initials: R
authors.lastname: Clark
mesh_terms: D002985:Clinical Protocols; D019317:Evidence-Based Medicine / Q000458:organization & administration; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007224:Infant Care / Q000379:methods* / Q000458:organization & administration*; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D015931:Intensive Care, Neonatal / Q000379:methods / Q000458:organization & administration; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D011030:Pneumothorax / Q000453:epidemiology* / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D011446:Prospective Studies; D018570:Risk Assessment