Quality improvement models in neonatal care

Quality improvement (QI) is a systematic, formal approach to the analysis of practice performance and efforts to improve performance. Understanding and properly implementing QI is essential to a well-functioning practice, and is necessary for any practice interested in improving efficiency, patient safety, or clinical outcomes. Quality improvement is the combined and unceasing efforts of everyone healthcare professionals, patients and their families, researchers, payers, planners and educators to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development (learning). The concepts of high reliability, which are derived from studying other high-risk industries, are now being applied to complex adaptive health systems such as NICU. The aim of the quality improvement movement is to enable clinicians to care for their patients so that the care outcomes are the best that can be achieved. In neonatal care, there have been many rapid medical advances that have decreased mortality and morbidity. One can question the case for quality improvement. We need to ask whether this is the best we can do.Although there has been a considerable reduction in the number of neonatal deaths in the NICU during the last two decades, it is the management of critically ill infants that has become of major concern, as they are continuously exposed to various risk factors. These factors include exposure to various stressors in NICU such as light and noises, exposure to severe infections, high risk of accidental extubations, and invasive procedures. All these factors have a detrimental effect on the growth and neurodevelopment of the critically ill preterm infants. As most of these causes are preventable, it is important to adopt various proven quality improvement initiatives to improve neonatal care outcomes. The Models for Improvement consisted of Rapid Cycle Quality Improvement, PDSA, Human Factors, Lean Methodology, 5S, Failure Modes and Effects Analysis, Root Cause Analysis and EPIQ. Evidence-based practice is key to providing good health care. Yet, there are large variations in practice among Canadian neonatal intensive care units (NICU) and suitable models for implementing practice change based on evidence and data are lacking. The Evidence-based Practice for Improving Quality (EPIQ) is a QI method for neonatal intensive care units (NICUS) that tailors evidence-based practice change to each NICU. This includes identifying site-specific associations between practices and outcomes through baseline data analysis; involving NICU teams in systematic evidence reviews; identifying barriers to change; developing evidence-based, site-specific priorities and practice-change strategies; monitoring compliance; and providing tailored support for continuous QI using the Plan-Do-Study-Act model. The successes from EPIQ demonstrate how a national network of clinicians, front-line workers, and researchers can engage in a collaborative system that utilizes their cumulative experience and expertise, to encourage evidence-based practice for improving quality. EPIQ is innovative because it establishes a national system for on-going evidence-based quality improvement.