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A quality improvement initiative to reduce necrotizing enterocolitis across hospital systems

Abstract

Objective

Necrotizing enterocolitis (NEC) is a devastating intestinal disease in premature infants. Local rates of NEC were unacceptably high. We hypothesized that utilizing quality improvement methodology to standardize care and apply evidence-based practices would reduce our rate of NEC.

Study design

A multidisciplinary team used the model for improvement to prioritize interventions. Three neonatal intensive care units (NICUs) developed a standardized feeding protocol for very low birth weight (VLBW) infants, and employed strategies to increase the use of human milk, maximize intestinal perfusion, and promote a healthy microbiome.

Results

The primary outcome measure, NEC in VLBW infants, decreased from 0.17 cases/100 VLBW patient days to 0.029, an 83% reduction, while the compliance with a standardized feeding protocol improved.

Conclusion

Through reliable implementation of evidence-based practices, this project reduced the regional rate of NEC by 83%. A key outcome and primary driver of success was standardization across multiple NICUs, resulting in consistent application of best practices and reduction in variation.

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Acknowledgements

We would like to acknowledge Trayce Gardner, RD, Stacie Chapman, RD, Carrie Smith, RD, and Jackie Wessel, RD. IRB approval was determined to not be required as this work was considered quality improvement, and not human subjects research.

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Correspondence to Amy T. Nathan.

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The authors declare that they have no conflict of interest.

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Nathan, A.T., Ward, L., Schibler, K. et al. A quality improvement initiative to reduce necrotizing enterocolitis across hospital systems. J Perinatol 38, 742–750 (2018). https://doi.org/10.1038/s41372-018-0104-0

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