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  • Quality Improvement Article
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Diagnosis and management of cardiopulmonary events in very low birth weight infants close to discharge: a quality improvement initiative

Journal of Perinatology volume 42, pages 803–808 (2022)Cite this article

Subjects

Abstract

Background

Cardiopulmonary events (CPE) have a central, obstructive, or mixed etiology. Lack of standardized diagnosis and management of CPE may prolong the length of stay (LOS).

Objective

To increase the accuracy of CPE diagnosis and decrease LOS by 10% for preterm infants over a 12-month period.

Methods

Develop an evidence-based algorithm to identify type of CPE, determine management approach, and evaluate cardio-respiratory monitors output. Apply model for improvement and statistical process control charts to determine special cause variation.

Results

Identification of central apnea increased from 15 to 39% (p < 0.01). LOS decreased 26% from 52.6 days to 39.2 days, with an estimated cost savings of $13,119 per each of the 225 infants in the initiative.

Conclusion

After implementing an evidence-based algorithm for management of neonatal CPE, a significant increase in the accuracy of the diagnosis of central apnea and cost savings associated with a decrease in LOS were observed.

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Fig. 1: Cardiorespiratory Event Algorithm Developed by Multidisciplinary Quality Improvement Team.
Fig. 2: Statistical Process Control Chart for Length of Stay.

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Author information

Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC, USA

    Jennifer L. N. Holman & Jennifer F. Check

  2. Department of Academic Nursing, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Tinisha M. Lambeth

  3. Colombian Neonatal Association (ASCON), Bogota, Colombia

    Mario A. Rojas

  4. Professor of Pediatrics, Universidad Industrial de Santander, Bucaramanga, Colombia

    Mario A. Rojas

Authors
  1. Jennifer L. N. Holman
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  2. Tinisha M. Lambeth
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  3. Jennifer F. Check
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  4. Mario A. Rojas
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Contributions

JH helped conceptualize and design the study, played a key role in implementation, data collection and analyses, drafted the initial paper, and reviewed and revised the paper. TL played a key role in the Q.I. design and analysis of the data, assisted in the implementation, and reviewed and revised the paper. JC helped with all the statistical analyses and reviewed and revised the paper. MR conceptualized and helped design the study, assisted in the implementation, and critically reviewed and revised 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 Jennifer L. N. Holman.

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The authors declare no competing interests.

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Holman, J.L.N., Lambeth, T.M., Check, J.F. et al. Diagnosis and management of cardiopulmonary events in very low birth weight infants close to discharge: a quality improvement initiative. J Perinatol 42, 803–808 (2022). https://doi.org/10.1038/s41372-022-01367-9

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  • DOI: https://doi.org/10.1038/s41372-022-01367-9

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