title: Quality improvement measures in pulse-oximetry newborn heart screening: a time series analysis.
abstract: OBJECTIVE
  The use of pulse-oximetry screening to detect critical congenital heart defects in newborns has gained national and international momentum in the past decade. Our hospital system began screening in 2008. Since then, our program has undergone leadership changes and multiple quality improvement interventions. The aims of this study are to evaluate the evolution of our pulse-oximetry program and to provide insights from lessons learned over the course of a long-standing program.
  
  
  METHODS
  We reviewed 6 years of screening data and evaluated trends of missed screens, false-positives, protocol violations, and parental decline of screening. We implemented 3 quality improvement interventions (change in protocol, redesign of an electronic medical record documentation system to autocalculate results, and transition from research to standard-of-care) and reviewed the impact of a rigorous quality assurance review process. We used linear regression and statistical process control charts to evaluate the data.
  
  
  RESULTS
  A total of 18,363 newborns were screened; we identified 5 critical cases. We observed a significant decrease in missed (P < .001) and false-positive (P = .03) screens over time but found no significant trend in the rate of percentage of protocol violations (P = .26) or decline of screening (P = .99). Each metric showed behavior attributable to at least 1 quality improvement intervention.
  
  
  CONCLUSIONS
  We established a sustainable pulse-oximetry screening program in our community hospital system, and the screening has now become routine. The quality of our screening was influenced by choice of screening protocol, rigor of quality assurance reviews, and the process used to interpret screening results.
authors.affiliation: MultiCare Institute for Research and Innovation, Tacoma, Washington;
authors.forename: Bethann Mangel
authors.initials: BM
authors.lastname: Pflugeisen
authors.affiliation: MultiCare Institute for Research and Innovation, Tacoma, Washington;
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Amoroso
authors.affiliation: Mary Bridge Children's Hospital and Health Center, Tacoma, Washington;
authors.forename: Diane
authors.initials: D
authors.lastname: Zook
authors.affiliation: Children's Hospital of Illinois and the University of Illinois College of Medicine, Peoria, Illinois; and.
authors.forename: Karl F
authors.initials: KF
authors.lastname: Welke
authors.affiliation: MultiCare Institute for Research and Innovation, Tacoma, Washington;
authors.forename: Anne
authors.initials: A
authors.lastname: Reedy
authors.affiliation: NorthWest Congenital Heart Care, Pediatrix Cardiology, Tacoma, Washington matthew_park@pediatrix.com.
authors.forename: Matthew V
authors.initials: MV
authors.lastname: Park
mesh_terms: D057286:Electronic Health Records; D006284:Health Plan Implementation / Q000379:methods / Q000592:standards; D006330:Heart Defects, Congenital / Q000175:diagnosis*; D006764:Hospitals, Community; D006801:Humans; D007231:Infant, Newborn; D015997:Neonatal Screening / Q000379:methods* / Q000592:standards; D010092:Oximetry / Q000379:methods* / Q000592:standards*; D058996:Quality Improvement / Q000592:standards*; D059039:Standard of Care / Q000458:organization & administration / Q000592:standards; D014861:Washington
keywords: critical congenital heart disease; pulse-oximetry; quality improvement