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  • Quality Improvement Article
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A quality improvement project improving the value of iNO utilization in preterm and term infants

Abstract

Objective

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.

Project design

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.

Results

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.

Conclusions

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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Fig. 1: iNO management guideline.
Fig. 2: Total iNO hours per month for term (a) and preterm (b) infants.
Fig. 3: Average iNO hours per patient per month for term (a) and preterm (b) infants.
Fig. 4: Percentage of prolonged iNO courses > 120 h per month for term (a) and preterm (b) infants.

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Acknowledgements

The authors thank to Lloyd P Provost, MS for assistance with data transformation and review of paper.

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Authors and Affiliations

Authors

Contributions

HF and TS conceptualized the study design, collected and analyzed data, implemented interventions, drafted, reviewed, and revised the paper. LD, SD, OO, TR, SS, and ST participated in designing and testing interventions, analyzing data, drafting, and reviewing the paper. All authors approved the final paper as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Hannah Fischer.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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 41, 164–172 (2021). https://doi.org/10.1038/s41372-020-0768-0

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