Inhaled NO (iNO) is used in the NICU for management of hypoxemic respiratory failure. The cost of iNO is significant and does not consistently improve outcomes in infants <34 weeks.
Our team used The Model for Improvement to design a quality improvement project to utilize iNO for appropriate indications, ensure response to therapy and initiate timely weaning. The project was carried out at a Level IV NICU and successful interventions spread to a smaller Level III NICU.
This project demonstrated significant improvement in all measures; total iNO hours per month, average iNO hours per patient, and the percentage of prolonged iNO courses. With an estimated cost of $115/h, the cost per patient for iNO use declined by half from $21,620 to $10,580.
Our team improved the value of iNO utilization at our institution and spread successful interventions to another NICU in our network.
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The authors thank to Lloyd P Provost, MS for assistance with data transformation and review of paper.
Conflict of interest
The authors declare that they have no conflict of interest.
This project was determined to be nonhuman subjects research by the University of Louisville Institutional Review Board and Norton Children’s Hospital Research Board. Balancing measures monitored for prevention of patient harm included mortality, escalation of care to ECMO, the number of infants requiring reinstitution of iNO within 24 h of weaning, and utilization of the pulmonary hypertension consult.
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Fischer, H., Singh, T., Devlin, L. et al. A quality improvement project improving the value of iNO utilization in preterm and term infants. J Perinatol (2020). https://doi.org/10.1038/s41372-020-0768-0