BOOK
Quality Improvement in Neonatal and Perinatal Medicine, An Issue of Clinics in Perinatology - E-Book
Alan R. Spitzer | Dan Ellsbury
(2010)
Additional Information
Book Details
Abstract
This issue of Clinics in Perinatology, guest edited by Drs. Alan Spitzer and Dan Ellsbury, examines Quality Improvement in Neonatal and Perinatal Medicine. The first part of the issue addresses Tools of Quality Improvement and includes articles on The Quality Chasm in Neonatal and Perinatal Medicine; Evaluating the Medical Evidence; The Vermont Oxford Network Database; The Pediatrix Clinical Data Warehouse; Role of Regional Collaboratives: The California Perinatal Quality Care Collaborative Model; A Primer on Quality Improvement Methodology; Using Statistical Process Control Methodology; Human Factors in Quality Improvement, Random Safety Audits, Root Cause Analysis, and Failure Mode and Effects Analysis; Collaboration Between Obstetricians and Neonatologists: Perinatal Safety Programs and Improved Clinical Outcomes; and Pay for Performance: A Business Strategy for Quality Improvement in Neonatal-Perinatal Medicine. The second part of this issue addresses Specific Applications of Documented Quality Improvement Methodology in Neonatal and Perinatal Medicine and includes articles on Delivery Room Intervention-Improving the Outcome, Reducing Retinopathy of Prematurity, Improving Breast Milk Use During and After the NICU Stay, Decreasing Catheter Related Bloodstream Infection, and Decreasing Bronchopulmonary Dysplasia.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Contributors | iii | ||
| Contents | vii | ||
| Preface | xv | ||
| Chapter 1. Crossing the Quality Chasm in Neonatal-Perinatal Medicine | 1 | ||
| WHAT IS THE QUALITY CHASM? | 1 | ||
| THE QUALITY CHASM IN NEONATOLOGY | 1 | ||
| SYSTEMS THINKING | 3 | ||
| COMPLEX ADAPTIVE SYSTEMS | 4 | ||
| TYPES OF CHANGE: TINKERING AND SYSTEM CHANGE | 5 | ||
| USING SIMPLICITY TO CROSS THE CHASM OF COMPLEXITY | 5 | ||
| SUMMARY | 6 | ||
| REFERENCES | 6 | ||
| Chapter 2. Evaluating the Medical Evidence for Quality Improvement | 11 | ||
| FORMULATING THE QUESTION | 12 | ||
| FINDING THE EVIDENCE | 13 | ||
| CONDUCTING THE SEARCH | 14 | ||
| APPRAISING THE EVIDENCE | 14 | ||
| APPLICABILITY | 18 | ||
| EVALUATING PERFORMANCE: THE ROLE OF QUALITY IMPROVEMENT | 20 | ||
| SUMMARY | 25 | ||
| ACKNOWLEDGMENTS | 25 | ||
| REFERENCES | 25 | ||
| Chapter 3. The Vermont Oxford Network: A Community of Practice | 29 | ||
| VLBW DATABASE | 29 | ||
| EXPANDED DATABASE FOR ALL NICU INFANTS | 30 | ||
| DATA SUBMISSION | 30 | ||
| RISK ADJUSTMENT | 30 | ||
| DATABASE RESEARCH | 36 | ||
| MEMBER REPORTING | 36 | ||
| NIGHTINGALE | 37 | ||
| QUALITY IMPROVEMENT | 39 | ||
| NATIONAL QUALITY MEASURES | 42 | ||
| RANDOMIZED CONTROLLED TRIALS | 42 | ||
| FOLLOW-UP | 43 | ||
| WORLDWIDE COMMUNITY OF PRACTICE | 44 | ||
| ACKNOWLEDGMENT | 45 | ||
| REFERENCES | 45 | ||
| Chapter 4. The Pediatrix BabySteps ® Data Warehouse and the Pediatrix QualitySteps Improvement Project System—Tools for ‘‘Meaningful Use’’ in Continuous Quality Improvement | 49 | ||
| BABYSTEPS DEVELOPMENT AND DATA EXTRACTION | 51 | ||
| GOALS FOR DATA EXTRACTION FROM BABYSTEPS, THE BABYSTEPS DATA WAREHOUSE | 53 | ||
| BABYSTEPS DATA WAREHOUSE REPORTS | 55 | ||
| THE DATA WAREHOUSE IN QUALITY IMPROVEMENT | 60 | ||
| THE QUALITY IMPROVEMENT PROJECT SYSTEM (QUALITYSTEPS) | 63 | ||
| SUMMARY | 68 | ||
| REFERENCES | 68 | ||
| FURTHER READINGS | 69 | ||
| Chapter 5. The Role of Regional Collaboratives: The California Perinatal Quality Care Collaborative Model | 71 | ||
| THE CASE FOR A REGIONAL APPROACH TO PERINATAL QUALITY IMPROVEMENT | 71 | ||
| THE NATURE OF A REGIONAL PERINATAL QUALITY CARE COLLABORATIVE | 73 | ||
| ROLE OF THE MISSION STATEMENT AND DEFINITION OF ORGANIZATIONAL PHILOSOPHY | 75 | ||
| OVERVIEW OF CPQCC AND ITS ORGANIZATIONAL STRUCTURE | 78 | ||
| THE QUALITY IMPROVEMENT CHALLENGE | 80 | ||
| QUALITY IMPROVEMENT | 83 | ||
| RESEARCH | 85 | ||
| ON COLLABORATION | 86 | ||
| REFERENCES | 86 | ||
| Chapter 6. A Primer on Quality Improvement Methodology in Neonatology | 87 | ||
| WHICH PROBLEM SHOULD ONE SELECT? | 87 | ||
| WHO SHOULD BE ON THE PROJECT TEAM? | 88 | ||
| EXAMPLES OF EFFECTIVE TEAM COMPOSITION | 89 | ||
| PROCESS MAPPING | 93 | ||
| PARETO CHARTS | 93 | ||
| SYSTEM CHANGES VERSUS TINKERING | 94 | ||
| CHANGE CONCEPTS | 94 | ||
| CHANGE PACKAGES | 95 | ||
| BUNDLES | 95 | ||
| MAINTAINING THE GAIN | 98 | ||
| SUMMARY | 98 | ||
| ACKNOWLEDGMENT | 98 | ||
| REFERENCES | 98 | ||
| Chapter 7. Navigating in the Turbulent Sea of Data: The Quality Measurement Journey | 101 | ||
| WHERE AWAY AND WHY ALONE? | 101 | ||
| WHY ARE YOU MEASURING? | 101 | ||
| THE QUALITY MEASUREMENT JOURNEY | 103 | ||
| ACKNOWLEDGMENTS | 121 | ||
| REFERENCES | 121 | ||
| Chapter 8. Human Factors and Quality Improvement | 123 | ||
| BACKGROUND AND DEFINITION | 123 | ||
| HISTORY OF HFE AND ITS USE IN HEALTH CARE | 124 | ||
| APPLICATIONS OF HFE IN IMPROVING HEALTH CARE QUALITY AND SAFETY | 124 | ||
| UNDERSTANDING USER REQUIREMENTS | 127 | ||
| EXAMPLES OF APPLICATION OF HFE PRINCIPLES IN THE NICU | 128 | ||
| SUMMARY | 132 | ||
| APPENDIX 1: LABELS AND DISPLAYS | 132 | ||
| HUMAN FACTORS CHECKLIST: LABELS AND DISPLAYS | 136 | ||
| REFERENCES | 138 | ||
| Chapter 9. Random Safety Auditing, Root Cause Analysis, Failure Mode and Effects Analysis | 141 | ||
| RANDOM SAFETY AUDITING | 142 | ||
| ROOT CAUSE ANALYSIS | 147 | ||
| FAILURE MODE AND EFFECTS ANALYSIS | 151 | ||
| REFERENCES | 154 | ||
| APPENDIX 1: POTENTIAL RANDOM AUDIT QUESTIONS | 157 | ||
| Chapter 10. Pay for Performance in Neonatal-Perinatal Medicine—Will the Quality of Health Care Improve in the Neonatal Intensive Care Unit? A Business Model for Improving Outcomes in the Neonatal Intensive Care Unit | 167 | ||
| MEANINGFUL PAY FOR PERFORMANCE—IDENTIFYING THE PROBLEM | 171 | ||
| PAY FOR PERFORMANCE: THE SEQUENCE AND APPROPRIATE MOTIVATION | 173 | ||
| PAY-FOR-PERFORMANCE RESULTS TO DATE | 175 | ||
| SUMMARY | 176 | ||
| REFERENCES | 176 | ||
| Chapter 11. Collaboration Between Obstetricians and Neonatologists: Perinatal Safety Programs and Improved Clinical Outcomes | 179 | ||
| THE SETON FAMILY OF HOSPITALS’ EXPERIENCE | 180 | ||
| OTHER COLLABORATIVE EFFORTS | 185 | ||
| REFERENCES | 188 | ||
| Chapter 12. Delivery Room Intervention: Improving the Outcome | 189 | ||
| MEASUREMENT OF INTERVENTION AND OUTCOMES | 189 | ||
| TEAM AND LEADERS | 190 | ||
| REFERENCES | 199 | ||
| Chapter 13. Comprehensive Oxygen Management for the Prevention of Retinopathy of Prematurity: The Pediatrix Experience | 203 | ||
| WHY WAS COMP-ROP SUCCESSFUL? | 204 | ||
| THE COMP-ROP PROGRAM | 205 | ||
| QUESTIONS AND BARRIERS ENCOUNTERED DURING THE IMPLEMENTATION OF COMP-ROP | 212 | ||
| SUMMARY | 212 | ||
| ACKNOWLEDGMENTS | 213 | ||
| REFERENCES | 213 | ||
| FURTHER READINGS | 214 | ||
| Chapter 14. Improving the Use of Human Milk During and After the NICU Stay | 217 | ||
| DOSE AND EXPOSURE PERIOD: PRECISE MEASUREMENT OF HUMAN MILK USE IN THE NICU | 218 | ||
| CRITICAL EXPOSURE PERIODS FOR THE USE OF HUMAN MILK | 219 | ||
| BEST NICU PRACTICES TO INCREASE DOSE AND EXPOSURE PERIOD OF HUMAN MILK FEEDINGS | 226 | ||
| USING LACTATION TECHNOLOGIES TO MANAGE HUMAN MILK FEEDING PROBLEMS | 233 | ||
| SUMMARY | 235 | ||
| REFERENCES | 236 | ||
| Chapter 15. Decreasing Central Line Associated Bloodstream Infection in Neonatal Intensive Care | 247 | ||
| WHY DOES CONTEXT MATTER? | 248 | ||
| MICROBIOLOGY | 250 | ||
| SUMMARY | 263 | ||
| REFERENCES | 263 | ||
| Chapter 16. Quality Improvement in Respiratory Care: Decreasing Bronchopulmonary Dysplasia | 273 | ||
| NOMENCLATURE AND DEFINITION | 273 | ||
| CLINICAL PRESENTATION AND PATHOPHYSIOLOGY | 274 | ||
| WHY QI TO REDUCE CLD? | 276 | ||
| PREVENTATIVE MEASURES TO LOWER THE INCIDENCE OF CLD: PBPS | 278 | ||
| QI: METHODS FOR IMPLEMENTATION AND SUCCESS | 284 | ||
| WHY HAVE QI INITIATIVES NOT BEEN UNIFORMLY SUCCESSFUL IN REDUCING CLD RATES? | 286 | ||
| REFERENCES | 287 | ||
| Index | 295 |