The neonatologists and neonatal nurse practitioners of Pediatrix® Neonatology of Michigan are not just committed to providing care to newborns; they are committed to continually improving the quality of that care to enhance patient outcomes.
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For more than 10 years, Pediatrix Neonatology of Michigan has taken strides to improve its process of care to reduce morbidity and improve its patients’ outcomes. The group, which provides services at Covenant Medical Center in Saginaw, holds weekly multidisciplinary quality improvement meetings to discuss quality metrics such as hospital-acquired infections, preventable adverse events, length of stay (LOS), readmissions and specific morbidities (including intraventricular hemorrhage (IVH), retinopathy of prematurity and chronic lung disease). Root-cause analyses are conducted to identify opportunities for improvement. Clinicians review evidence-based best practices and implement potentially better practices in Plan-Do-Study-Act (PDSA) cycles.
The practice is involved with a variety of quality improvement efforts, including projects through Pediatrix’s Center for Research, Education, Quality and Safety, as well as state and national efforts with the Michigan Neonatal Collaborative and the Vermont Oxford Network. They also participate in the Tiny Baby Collaborative, an effort spearheaded by physicians and researchers at Pediatrix (led by Dan Ellsbury, M.D., Pediatrix’s national director of neonatology quality and safety).
“Because providing quality care is our top priority, everyone on our team is committed to playing an essential role, including physicians, nurse practitioners, nursing leadership, respiratory therapists, dieticians and infection control staff,” explains Martin Nwankwo, M.D., a neonatologist and the practice’s medical director. “Everyone takes their roles seriously, and if a measure starts trending in the wrong direction, we work together to initiate change quickly.”
Making changes locally to benefit babies in Michigan
The practice’s clinicians are proud of two recent continuous quality improvement projects aimed at reducing LOS for late-preterm infants and decreasing the risk of IVH, a type of bleeding in the ventricles of the brain.
In spring 2020, Covenant Medical Center tasked the group with reducing LOS for well preterm infants (those born weighing more than 1,800 grams and/or born at 34 to 36 weeks). The group focused on developing a standard feeding guideline to reduce time in the hospital. The guidelines included:
- Admission criteria for intravenous fluids (i.e., hypoglycemia, moderate to severe respiratory distress)
- Early initiation of enteral feeds (tube feeding)
- Increased consistency among providers for advancing feeding schedules
- Early referral to occupational therapy for feeding difficulties
Through these efforts, the time to full-nipple feeds decreased, which reduced the average LOS from 18 days to 16 days — a 10% decrease.
In another initiative that began in 2019, the group collaborated with Covenant obstetrical providers to implement delayed cord clamping (DCC) for all infants less than 34 weeks gestation to decrease patients’ risk of developing IVH, a condition common in extremely low birth weight babies. This change resulted in an increase in DCC from 35% to 72% and a decrease in cases of severe IVH in 2020.
However, when the team noticed that delayed cord clamping was not being done in an increasing number of infants born in the first six months of 2021, they brought their concerns to the hospital’s obstetrics section meeting. As a result, in the last half of 2021, DCC rates again returned to 72%, and the rate of severe IVH again dropped in those infants who received the intervention.
As an extension to the DCC project, the team also collaborated with obstetrical providers to develop a guideline for pregnant women who present at 22 to 23 weeks of gestation. Antenatal steroids are now considered at 22 weeks, and the team is present at delivery to assess the infant and manage resuscitative efforts if appropriate. The team recently discharged to home an extremely preterm infant who benefited from the standardized approach the team developed.
“Parents want to know that their babies are well taken care of and are receiving the highest quality care,” says Staci Boyke, NNP, lead neonatal nurse practitioner with Pediatrix Neonatology of Michigan. “We’re continually measuring how we meet evidence-based standards and are always willing to learn new ways to ensure care is safe.”
Pediatrix Medical Group has cultivated a culture of continuous quality improvement and safety. It is the cornerstone of our success and helps us fulfill our mission to Take great care of the patient, every day and in every way. ™ Learn more.