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Measuring practice preference variation for quality improvement in neonatal respiratory care

Journal of Perinatology (2024)Cite this article

Subjects

Abstract

Objectives

The authors sought to measure and compare practice preference variation in neonatal respiratory care within and between neonatal intensive care units (NICUs) using the Neonatology Survey of Interdisciplinary Groups in Healthcare Tool (NSIGHT).

Study design

Eleven NICUs completed the NSIGHT between 2019 and 2021. Net preference was measured by mean response; agreement was ranked by standard distribution of response values. Heat maps showed comparisons between NICUs and disciplines.

Results

NICUs and individuals agreed most often on use of pressure support with mandatory ventilation and on use of non-invasive positive pressure ventilation for apnea. High preference variation surrounded decisions for invasive ventilation versus continuous positive airway pressure for extremely low birth weight infants. Preference difference was most frequent between neonatologists and nurses.

Conclusions

Patterns of practice preference variation in neonatal respiratory care are specific to clinical scenario. Measuring preference variation may inform psychology of change and strengthen quality improvement efforts.

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Fig. 1
Fig. 2: NSIGHT response heat map.
Fig. 3: Agreement between disciplines.

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Data availability

The dataset generated during the current study is not publicly available as it contains information that identifies the participating site. Data is available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

    Helen Healy, Emily Whitesel, Wenyang Mao, John A. F. Zupancic & Munish Gupta

  2. University of Florida Jacksonville/Wolfson Children’s Hospital, Jacksonville, FL, USA

    Colby L. Day

  3. Goryeb Children’s Hospital, Morristown, NJ, USA

    Thomas G. Murphy

  4. University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    Clara H. Song & Patricia K. Williams

  5. Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, Manhattan, NY, USA

    Sandhya S. Brachio

  6. Michigan Medicine, Ann Arbor, MI, USA

    Parul Cham & Rebecca J. Vartanian

  7. Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Steven Chin & Puneet Arora

  8. Yale New Haven Children’s Hospital, New Haven, CT, USA

    Matthew Bizzarro

  9. Connecticut Children’s, Hartford, CT, USA

    David W. Sink

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  1. Helen Healy
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Contributions

HH, EW, JAFZ, and MG, conceptualized and designed the study, including the vignettes used, drafted the initial manuscript, carried out the initial analyses, and critically reviewed and revised the manuscript. WM researched and developed analyses methods and designed and produced visual representation heat maps, as well as contributed to drafting of the original manuscript. CLD, TGM, CHS, PKW, SSB, PC, RJV, SC, PA, MB, and DWS, all recruited participants, collected data, contributed to data interpretation, and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Helen Healy.

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The authors declare no competing interests.

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Healy, H., Whitesel, E., Mao, W. et al. Measuring practice preference variation for quality improvement in neonatal respiratory care. J Perinatol (2024). https://doi.org/10.1038/s41372-024-01956-w

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