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  • Quality Improvement Article
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Mortality in the neonatal intensive care unit: improving the accuracy of death reporting

Journal of Perinatology volume 42, pages 671–676 (2022)Cite this article

Subjects

Abstract

Objective

Death certificates commonly contain errors, which hinders understanding of infant mortality. We, therefore, undertook a quality improvement (QI) initiative to improve death reporting in our neonatal intensive care unit (NICU).

Study design

After our baseline assessment (January 1, 2015 to June 30, 2017), we implemented our QI initiatives using Plan, Do, Study, Act (PDSA) tests of change. We prospectively reviewed death certificates (July 1, 2017 to December 31, 2019) to evaluate the impact of our interventions.

Results

The overall proportion of incorrect death certificates significantly decreased from 71 to 22% with special cause variation noted after the second PDSA cycle. The most common errors involved inaccurate or incomplete reporting of prematurity and errors in the sequence of events.

Conclusion

Through a series of PDSA cycles focused on formal provider education and ongoing review, we significantly reduced inaccurate death reporting. These interventions are generalizable across NICUs and important to improve public health reporting accuracy.

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Fig. 1: Cause and effect diagram.
Fig. 2: Common errors on death certificates.
Fig. 3: Control chart, with interventions noted in the boxed text.

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Funding

MHW is supported by NIH K23 HD 102589-01. KTL is supported by a Boston Children’s Hospital Department of Pediatrics Quality Scholars Grant.

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Authors and Affiliations

  1. Division of Genetics and Genomics, Boston, MA, USA

    Monica H. Wojcik

  2. Division of Newborn Medicine, Boston, MA, USA

    Monica H. Wojcik, Jenny Chan Yuen, Anne Hansen & Kristen T. Leeman

  3. Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA

    Monica H. Wojcik, Anne Hansen & Kristen T. Leeman

Authors
  1. Monica H. Wojcik
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  2. Jenny Chan Yuen
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  3. Anne Hansen
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  4. Kristen T. Leeman
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Contributions

MHW conceptualized and designed the study, collected data, carried out the analyses, drafted the initial manuscript, and reviewed and revised the manuscript. JCY contributed to the data analysis and reviewed and revised the manuscript. AH contributed to data collection and analysis and reviewed and revised the manuscript. KTL conceptualized and designed the study, contributed to data collection and analysis, and reviewed and revised the manuscript.

Corresponding author

Correspondence to Monica H. Wojcik.

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The authors declare no competing interests.

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Wojcik, M.H., Yuen, J.C., Hansen, A. et al. Mortality in the neonatal intensive care unit: improving the accuracy of death reporting. J Perinatol 42, 671–676 (2022). https://doi.org/10.1038/s41372-021-01214-3

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  • DOI: https://doi.org/10.1038/s41372-021-01214-3

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