Improving consistency and accuracy of neonatal amplitude-integrated electroencephalography

2021 ◽  
Author(s):  
Kathleen Tsoi ◽  
Karen Kwan Ming Yam ◽  
Hon Ming Cheung ◽  
Terence Ping Yuen Ma ◽  
King Woon So ◽  
...  
Keyword(s):  
Pattern Recognition ◽  
Professional Education ◽  
Neonatal Intensive Care ◽  
Outcome Indicators ◽  
Process Indicators ◽  
Pdsa Cycle ◽  
Number Of Patients ◽  
Recognition Ability ◽  
Level 3 ◽  
Electrographic Seizures

Objective: To improve the utilization of amplitude-integrated electroencephalography (aEEG) in a neonatal unit by improving aEEG documentation, aEEG knowledge and pattern recognition ability of neonatal staff. Methods: A quality improvement (QI) program comprising two plan-do-study-act (PDSA) cycles was conducted in a level 3 neonatal intensive care unit. The first cycle was focused on improving aEEG documentation with the primary outcome indicator being compliance with aEEG documentation. The second cycle was focused on aEEG interpretation in a healthcare professional education program with the outcome indicators being accuracy of seizure identification on aEEG and change in conventional EEGs (EEG) performed. Other outcome indicators included accuracy in identification of background pattern, sleep-wake cycles and artefacts. Process indicators included improvement in aEEG-related knowledge. Interventions: First PDSA cycle – lectures on aEEG interpretation, a bedside key and documentation form. Second PDSA cycle – online aEEG education pack, detailed aEEG guideline. Results: There was a significant improvement in aEEG documentation after the implementation of both PDSA cycles. 7 of the 46 patients (15.2%) had isolated electrographic seizures which would not have been identified in the pre-aEEG monitoring era. There was an increase in the number of patients with EEGs done, but a steady decrease in number of EEGs per patient. Conclusions: With the successful application of standardized QI methods, improvements in outcome indicators such as correct aEEG pattern recognition and improved coverage of at risk infants with EEGs were observed. Our QI measures were associated with improvement in aEEG pattern recognition.

Procedural Analgesia in the Neonatal Intensive Care Unit: A Quality Improvement Initiative

2021 ◽  
Author(s):  
Sushma Reddy ◽  
Saudamini V. Nesargi ◽  
Sofia Stevens ◽  
Jiya Jose ◽  
Hindumati Babu
Keyword(s):  
Quality Improvement ◽  
Neonatal Intensive Care ◽  
Quality Improvement Initiative ◽  
Chi Square ◽  
Process Indicators ◽  
Root Cause ◽  
Pdsa Cycle ◽  
Chi Square Test ◽  
Power Point ◽  
Written Test

Objective Neonates perceive pain which also has adverse long-term consequences. Newborns experience several painful procedures a day. Various methods of analgesia may be used but are underutilized. The SMART aim of this project was to increase the use of procedural analgesia from 11.5 to 75% in 6 months by using quality improvement principles. Study Design After a baseline audit, a root cause analysis was done. Based on this, a series of interventions were done as Plan-Do-Study-Act (PDSA) cycles. These included posters on analgesia, display of the pain protocol, orders for analgesia, a written test, small power point presentations on the importance of analgesia, and reminders on the trays used for procedures. At the end of each PDSA cycle, an audit was done to determine the proportion of times analgesia was used. Process indicators were also used when possible. Analysis was done by using the Chi-square test and the paired t-test. Results At baseline 11% of procedures were done after giving analgesia. This significantly improved to 40% at the end of the first PDSA, and 81% after third PDSA. This was sustained at 75% over the next 2 months. Conclusion Procedural analgesia can improve and be sustained by using simple interventions. Key Points

67 The Evolution of A Frailty Service

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
C Abbott ◽  
K Bishop ◽  
F Hill ◽  
C Finlow ◽  
R Maraj
Keyword(s):  
Cost Effectiveness ◽  
Patient Outcomes ◽  
Local Population ◽  
Management Team ◽  
Pdsa Cycle ◽  
North Wales ◽  
Number Of Patients ◽  
Constant State ◽  
Clinical Resource ◽  
Improve Patient

Abstract Introduction In September 2017 our frailty service was started within our medium sized DGH in North Wales. Working with our management team we secured a significant clinical resource including: We describe how resources, setting and staffing develop over a 2 year period in order to create a service which meets the needs of the local population. Method The service has been in a constant state of development since it has been in operation, utilising a PDSA model with regular meetings of clinical and managerial staff to analyse performance. Results With each new PDSA cycle the amount of patients reviewed has increased. With the move to AMU we increased the monthly number of patients reviewed from 29 to 172 patients reviewed, 97 of which were discharged directly from the unit. Conclusion Using QI methodology our Frailty Service has improved dramatically since its inception. We will continue to analyse how we work to improve patient outcomes and cost effectiveness.

Comparison of healthcare utilization and outcomes by gestational diabetes diagnostic criteria

2018 ◽  
Vol 46 (4) ◽  
pp. 401-409 ◽  
Author(s):  
Julianne R. Lauring ◽  
Allen R. Kunselman ◽  
Jaimey M. Pauli ◽  
John T. Repke ◽  
Serdar H. Ural
Keyword(s):  
Gestational Diabetes ◽  
Healthcare Utilization ◽  
Retrospective Cohort ◽  
Neonatal Intensive Care ◽  
Hospital Admissions ◽  
Neonatal Intensive Care Units ◽  
Maternal Healthcare ◽  
Number Of Patients ◽  
Significant Difference ◽  
Data Group

Abstract Objective: To compare healthcare utilization and outcomes using the Carpenter-Coustan (CC) criteria vs. the National Diabetes Data Group (NDDG) criteria for gestational diabetes mellitus (GDM). Methods: This is a retrospective cohort study. Prior to 8/21/2013, patients were classified as “GDM by CC” if they met criteria. After 8/21/2013, patients were classified as “GDM by NDDG” if they met criteria and “Meeting CC non-GDM” if they met CC, but failed to reach NDDG criteria. “Non-GDM” women did not meet any criteria for GDM. Records were reviewed after delivery. Results: There was a 41% reduction in GDM diagnosed using NDDG compared to CC (P=0.01). There was no significant difference in triage visits, ultrasounds for growth or hospital admissions. Women classified as “Meeting CC non-GDM” were more likely to have preeclampsia than “GDM by CC” women [OR 11.11 (2.7, 50.0), P=0.0006]. Newborns of mothers “Meeting CC non-GDM” were more likely to be admitted to neonatal intensive care units than “GDM by CC” [OR 6.25 (1.7, 33.3), P=0.006], “GDM by NDDG” [OR 5.56 (1.3, 33.3), P=0.018] and “Non-GDM” newborns [OR 6.47 (2.6, 14.8), P=0.0003]. Conclusion: Using the NDDG criteria may increase healthcare costs because while it decreases the number of patients being diagnosed with GDM, it may also increase maternal and neonatal complications without changing maternal healthcare utilization.

Late-onset pubic-phallic idiopathic edema in premature recovering infants

2018 ◽  
Vol 7 (2) ◽  
Author(s):  
Bengt-Ola S. Bengtsson ◽  
John P. van Houten
Keyword(s):  
Neonatal Intensive Care ◽  
Chart Review ◽  
Late Onset ◽  
Expectant Management ◽  
Retrospective Chart Review ◽  
Extremely Low Birth Weight ◽  
Genital Area ◽  
Level 3 ◽  
Prolonged Observation ◽  
Idiopathic Edema

AbstractObjectiveSeveral cases of isolated localized edema of the genital area in extremely low birth weight (ELBW) infants within the last 5 years prompted a search for possible explanations and a search of the literature.Study designA retrospective chart review of all cases of localized genital area edema in our 16-bed community level-3 neonatal intensive care unit (NICU) between January 2007 and December 2017.ResultsA total of six patients with localized edema of the genital area were found. Among the six cases, five provided descriptions of time of onset. Only one case had a plausible etiology [inguinal hernia (IH)].ConclusionsTo our knowledge, this entity is not well described in the literature. Etiologies are speculative. Prolonged observation in the NICU by virtue of ELBW-status suggests that there are no detrimental effects, the condition does not appear to preclude discharge and cautious expectant management and reassurance are therefore in order.

Early ultrasonographic follow up in neonatal pneumatocele. Two case reports

2018 ◽  
Vol 7 (2) ◽  
Author(s):  
Eugenia Maranella ◽  
Arianna Mareri ◽  
Marialuisa Tataranno ◽  
Luisa Di Luca ◽  
Alessandra Marciano ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Case Reports ◽  
Central Area ◽  
Neonatal Intensive Care Units ◽  
Promising Technique ◽  
Progressive Reduction ◽  
Number Of Patients ◽  
Chest X Ray ◽  
Pulmonary Parenchyma

Abstract Pulmonary pneumatocele is a thin-walled, air-filled cyst originating spontaneously within the lungs’ parenchyma, generally after infections or prolonged mechanical respiratory support. The diagnosis of pneumatocele is usually made using both chest X-ray (CXR) and computed tomography (CT) scan. Lung ultrasonography (LUS) is a promising technique used to investigate neonatal pulmonary diseases. We hereby present two cases of pneumatocele in newborns with respiratory distress syndrome (RDS) in which CXR and LUS were used to evaluate pulmonary parenchyma. LUS showed a multilobed cyst with a thin hyperechoic wall and a hypoechoic central area. Repeated LUS demonstrated a progressive reduction of the cyst’s size. After a few weeks, the small lesions were no longer detectable by ultrasound, therefore CXR was used, for follow-up, in the following months, until complete resolution. No data are available in the literature regarding ultrasonographic follow-up of neonatal pneumatocele. A larger number of patients are required to confirm our results and increase the use of LUS in the neonatal intensive care units (NICUs) to reduce neonatal radiations exposure.

scholarly journals Accuracy of real-time delivery room resuscitation documentation

2018 ◽  
Vol 105 (2) ◽  
pp. 222-224 ◽  
Author(s):  
Claire E Fishman ◽  
Danielle D Weinberg ◽  
Ashley Murray ◽  
Elizabeth E Foglia
Keyword(s):  
Heart Rate ◽  
Oxygen Saturation ◽  
Real Time ◽  
Vital Sign ◽  
Gold Standard ◽  
Neonatal Intensive Care ◽  
Video Recording ◽  
Neonatal Resuscitation ◽  
Delivery Room ◽  
Level 3

ObjectiveTo assess the accuracy of real-time delivery room resuscitation documentation.DesignRetrospective observational study.SettingLevel 3 academic neonatal intensive care unit.ParticipantsFifty infants with video recording of neonatal resuscitation.Main outcome measuresVital sign assessments and interventions performed during resuscitation. The accuracy of written documentation was compared with video gold standard.ResultsTiming of initial heart rate assessment agreed with video in 44/50 (88%) records; the documented heart rate was correct in 34/44 (77%) of these. Heart rate and oxygen saturation were documented at 5 min of life in 90% of resuscitations. Of these, 100% of heart rate and 93% of oxygen saturation values were correctly recorded. Written records accurately reflected the mode(s) of respiratory support for 89%–100%, procedures for 91%–100% and medications for 100% of events.ConclusionReal-time documentation correctly reflects interventions performed during delivery room resuscitation but is less accurate for early vital sign assessments.

scholarly journals Value-Based HIV Care: A Method to Improve Quality of HIV Care.

2020 ◽  
Author(s):  
Guido van den berk ◽  
Daoud Ait Moha ◽  
Janneke Stalenhoef ◽  
Marie-Jose Kleene ◽  
Narda van der Meche ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Care Delivery ◽  
Population Level ◽  
Care Quality ◽  
Hiv Care ◽  
First Year ◽  
Outcome Indicators ◽  
Number Of Patients ◽  
Care Path

Abstract Background : To support our goal of providing optimal HIV care to our patients, we started applying the value-based health care principle to the HIV care that we offer in our HIV center, measuring relevant health outcomes and costs to allow continuous implementation of improvements (Value-Based HIV Care; VBHiC). Methods : In line with the principles of Michael Porter, our approach consisted of the following steps: 1) Organizing into integrated practice units / describing the HIV care path; 2) Defining an HIV outcome indicator set; 3) Building an enabling information technology platform; 4) Integrating care delivery across separate facilities; 5) Moving to bundled payments for care cycles and 6) Expanding excellent services and interventions for improvement across geographic boundaries. Results : The following set of 9 outcome indicators was developed: undetectable HIV load within the first year of care; quality of life within the first year of care; mortality within the first year of care; retention in care; therapy effectiveness; therapy tolerance; cardiovascular risk; quality of life for every subsequent year and overall annual mortality. These indicators, which were evaluated retrospectively, are shown in figures 1-5. Collection of the underlying data started in January 2016. The HIV care path was also integrated into the electronic file system. Creation of the ability to monitor outcome indicators at patient level, population level and process level allowed us to implement a quality cycle (plan-do-study-act). Conclusion : Our Value-Based HIV Care approach facilitated structured evaluation of parameters that are of value to the patient. It also boosted the quality of the HIV care that we provide and allowed us to increase the number of patients to whom we can offer high quality HIV care.

Quality Improvement for Neonatal Nurses, Part II: Using a PDSA Quality Improvement Cycle Approach to Implement an Oral Feeding Progression Guideline for Premature Infants

2012 ◽  
Vol 31 (4) ◽  
pp. 215-222 ◽  
Author(s):  
Lenora Marcellus ◽  
Adele Harrison ◽  
Kathleen MacKinnon
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Parent Education ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Neonatal Intensive Care ◽  
Guideline Implementation ◽  
Oral Feeding ◽  
Care Providers ◽  
Pdsa Cycle

The development of clinical practice guidelines involving multiple health care providers presents a challenge in the neonatal intensive care unit (NICU). Implementation and evaluation of the guideline is as important as the development of the guideline itself. We explored the use of a quality improvement approach in the implementation of a feeding framework. A Plan-Do-Study-Act (PDSA) quality improvement cycle model was used to implement and evaluate a stepwise oral infant feeding guideline with emphasis on parent and care provider satisfaction. Three PDSA cycles were conducted, with each cycle resulting in modifications to use of the framework and development of knowledge translation and parent education techniques and tools. A PDSA cycle approach can be used effectively in guideline implementation and evaluation involving multidisciplinary health care professionals. This is Part II of a two-part series. Part I introduced the concept of quality improvement and tools for advancing practice changes.

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