title: Optimizing therapeutic hypothermia for neonatal encephalopathy.
abstract: OBJECTIVE
  Therapeutic hypothermia (TH) for neonatal encephalopathy is becoming widely available in clinical practice. The goal of this collaborative was to create and implement an evidence-based standard-of-care approach to neonatal encephalopathy, deliver consistent care, and optimize outcomes.
  
  
  METHODS
  The quality improvement process identified and used the Model for Improvement as a framework for improvement efforts. This was a Vermont Oxford Network Collaborative focused on optimizing TH in the treatment of neonatal encephalopathy. By using an evidence-based approach, Potentially Better Practices were developed by the topic expert, modified by the collaborative, and implemented at each hospital. These included the following: timely identification of at-risk infants, coordination with referring hospitals to ensure TH was available within 6 hours after birth, staff education for both local and referring hospitals, nonsedated MRI, incorporating amplitude-integrated EEG into a TH protocol, and ensuring standard neurodevelopmental follow-up of infants. Each center used these practices to develop a matrix for implementation.
  
  
  RESULTS
  Local self-assessments directed the implementation and adaptation of the Potentially Better Practices at each center. Resources, based on common identified barriers, were developed and shared among the group.
  
  
  CONCLUSIONS
  The implementation of a TH program to improve the consistency of care for patients in NICUs is feasible using standard-quality improvement methodology. The successful introduction of new interventions such as TH to the NICU culture requires a collaborative multidisciplinary team, use of a systematic quality improvement process, and perseverance.
authors.affiliation: Children's Mercy Hospitals & Clinics, Section of Neonatology, 2401 Gillham Rd, Kansas City, MO 64108, USA. slolsen@cmh.edu
authors.forename: Steven L
authors.initials: SL
authors.lastname: Olsen
authors.forename: Mitchell
authors.initials: M
authors.lastname: Dejonge
authors.forename: Alex
authors.initials: A
authors.lastname: Kline
authors.forename: Ellina
authors.initials: E
authors.lastname: Liptsen
authors.forename: Dongli
authors.initials: D
authors.lastname: Song
authors.forename: Betsi
authors.initials: B
authors.lastname: Anderson
authors.forename: Amit
authors.initials: A
authors.lastname: Mathur
mesh_terms: D003299:Cooperative Behavior; D002658:Developmental Disabilities / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D004569:Electroencephalography / Q000379:methods / Q000592:standards; D019317:Evidence-Based Medicine / Q000379:methods* / Q000592:standards*; D005240:Feasibility Studies; D006284:Health Plan Implementation / Q000458:organization & administration; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods* / Q000592:standards*; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration / Q000592:standards; D033183:Interdisciplinary Communication; D008991:Monitoring, Physiologic / Q000379:methods / Q000592:standards; D010865:Pilot Projects; D058996:Quality Improvement / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration; D012815:Signal Processing, Computer-Assisted; D015996:Survival Rate; D014187:Transportation of Patients / Q000458:organization & administration; D014481:United States