Improving newborn preventive services at the birth hospitalization: a collaborative, hospital-based quality-improvement project.
OBJECTIVE
The goal was to test the effectiveness of a statewide, collaborative, hospital-based quality-improvement project targeting preventive services delivered to healthy newborns during the birth hospitalization.


METHODS
All Vermont hospitals with obstetric services participated. The quality-improvement collaborative (intervention) was based on the Breakthrough Series Collaborative model. Targeted preventive services included hepatitis B immunization; assessment of breastfeeding; assessment of risk of hyperbilirubinemia; performance of metabolic and hearing screens; assessment of and counseling on tobacco smoke exposure, infant sleep position, car safety seat fit, and exposure to domestic violence; and planning for outpatient follow-up care. The effect of the intervention was assessed at the end of an 18-month period. Preintervention and postintervention chart audits were conducted by using a random sample of 30 newborn medical charts per audit for each participating hospital.


RESULTS
Documented rates of assessment improved for breastfeeding adequacy (49% vs 81%), risk for hyperbilirubinemia (14% vs 23%), infant sleep position (13% vs 56%), and car safety seat fit (42% vs 71%). Documented rates of counseling improved for tobacco smoke exposure (23% vs 53%) and car safety seat fit (38% vs 75%). Performance of hearing screens also improved (74% vs 97%). No significant changes were noted in performance of hepatitis B immunization (45% vs 30%) or metabolic screens (98% vs 98%), assessment of tobacco smoke exposure (53% vs 67%), counseling on sleep position (46% vs 68%), assessment of exposure to domestic violence (27% vs 36%), or planning for outpatient follow-up care (80% vs 71%). All hospitals demonstrated preintervention versus postintervention improvement of > or = 20% in > or = 1 newborn preventive service.


CONCLUSIONS
A statewide, hospital-based quality-improvement project targeting hospital staff members and community physicians was effective in improving documented newborn preventive services during the birth hospitalization.
Mercier
Charles E
CE
Department of Pediatrics, University of Vermont, Burlington, Vermont, USA. charles.mercier@vtmednet.org
Barry
Sara E
SE
Paul
Kimberley
K
Delaney
Thomas V
TV
Horbar
Jeffrey D
JD
Wasserman
Richard C
RC
Berry
Patricia
P
Shaw
Judith S
JS
D000293:Adolescent; D000328:Adult; D001942:Breast Feeding; D002662:Child Health Services / Q000458:organization & administration*; D003299:Cooperative Behavior; D017579:Domestic Violence; D005260:Female; D006320:Hearing Tests; D017325:Hepatitis B Vaccines; D006760:Hospitalization; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000517:prevention & control; D015370:Infant Equipment; D007231:Infant, Newborn; D008661:Metabolism, Inborn Errors / Q000175:diagnosis; D015997:Neonatal Screening; D011187:Posture; D011314:Preventive Health Services / Q000458:organization & administration*; D011785:Quality Assurance, Health Care; D012890:Sleep; D014028:Tobacco Smoke Pollution / Q000517:prevention & control; D014707:Vermont
D017325:Hepatitis B Vaccines; D014028:Tobacco Smoke Pollution