Overview & Opportunity

Women and Newborns Clinical Program has identified indicators of quality improvement that have relevance, measurability, and improvability relating to consistent practice. In turn, these can be utilized to improve care and, in many instances, improve cost efficiency and resource utilization.  Preliminary analyses suggest substantial variation between Intermountain hospitals in several aspects of care for patients in the Neonatal Intensive Care Unit (NICU) and the Special Care Nursery (SCN).  Best-practice management in the NICU is ultimately linked to reducing morbidity and mortality, as well as length of stay for our NICU and SCN patients.  Also, perceived forthcoming changes in reimbursement require that we improve management practices leading to more cost-efficient care while maintaining or improving the quality of care for these patients, both as inpatients and in the first year of life.   We assert that by standardizing care in the NICU and SCN, we will not only decrease mortality and morbidity and associated costs, but also decrease longer-term morbidity and costs.

2014 Goal for the Women & Newborns Clinical Program

Identify indicators of quality improvement that have relevance, measurability, and improvability relating to consistent practice, thereby improving care, cost efficiency, and resource utilization in the NICU/SCN.  Implement a new process to identify babies at risk for early onset sepsis due to maternal chorioamnionitis.
Clinical Challenges to Meet the Goal: The greatest challenge to process improvement will be to understand current processes and why the variations exist. In addition, it will be necessary for personnel to be willing to adapt their current practices to identified best practices in order to create improvement, i.e., the challenge of change.   Achievement of this Board Goal will require acceptance and commitment on the part of hospital administration, NICU nursing administration, and physicians. Due to lack of electronic nursing documentation collection of data may create a challenge.
Challenges specific to the  SCN include;
1.       Providers do not document electronically, making it difficult to drill down on specifics in that population.
2.       Broad variation in patient population. 
3.       Limited resources at the smaller facilities. 
4.       Education needs related to diverse physician specialty training (FP vs     Peds vs Neo) and the frequency of any individual seeing any given disease/patient problem.
Methodology: Identify key processes within the realm of NICU/SCN care that demonstrate high variation between units.  Utilize teams to identify best practices and process changes that result in meaningful improvement for the identified processes.  For stretch goal we will utilize the Kaiser quantitative model to estimate the probability of neonatal early-onset bacterial infection on the basis of maternal intrapartum risk factors.
Exclusions: None 
Baseline:  Identify areas of practice variation within the NICU/SCN population
Entry Goal:  Complete 1 of 3                                      
1. Analyze utilization of resources with the NICU/SCN population including laboratory, respiratory, pharmacy, imaging, and nursing.  
2. Drill down on selected areas of over/under utilization of resources and determine opportunities for improvement.                                  
3. Decrease by 50% the number of babies identified as being at risk for early onset sepsis due to maternal chorioamnionitis and  requiring a laboratory evaluation, antibiotic therapy and a higher level of nursery care.
Target Goal: Complete 2 of 3
Stretch Goal: Complete 3 of 3 
Timeline:  Education will be conducted for early onset sepsis in the first quarter followed by implementation in the second quarter and measurement in the third and fourth quarters. 
Measurement Time Period: Third and Fourth Quarter 2014

 Women & Newborns Clinical Program Contacts

NameJob TitleBusiness PhoneEmail Address
Teri Kiehn, MS,
D. Ware Branch, MDMedical
Kristi Nelson, MBA, RNData
Erick Henry, MPHData
Amy LovatoAdministrative
Cempaka MartialData
Cathy HarrisOutreach Education

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