Clinical process improvement: reduction of pneumothorax and mortality in high-risk preterm infants.
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.
Walker
M Whit
MW
The Children's Hospital, Greenville Hospital System, Greenville, SC 29605, USA.
Shoemaker
Mike
M
Riddle
Kim
K
Crane
Martin M
MM
Clark
Reese
R
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