Infections in Premature Infants Drop Dramatically Due to Collaboration Throughout Ohio

Monday, February 21, 2011

A statewide quality improvement project that included 24 newborn intensive care units throughout Ohio has led to a significant reduction of infections in preterm infants.

The research, conducted by healthcare providers involved with the Ohio Perinatal Quality Collaborative (OPQC), resulted in a 20 percent reduction in infections due to creation of a standard set of guidelines governing the use of catheters for infants born at 22 to 29 weeks gestation. The guidelines set strict protocols for everything from assessing the need for catheters to their insertion and maintenance over time.

The research provides further evidence that evidence-based collaboration in quality improvement can advance child health and reduce healthcare costs.

The study will be published online Feb. 21 in Pediatrics, the journal of the American Academy of Pediatrics.

“This effort provides support for the important role of reliability principles in improving the application of evidence in practice,” says Heather Kaplan, MD, a physician at Cincinnati Children’s Hospital Medical Center and the study’s lead author. “To achieve Improvements beyond 20 percent may require attention to other aspects of care, such as nutrition and the integrity of skin care. This is where further research is needed.”

Preterm birth is the leading cause of infant mortality in Ohio, which ranks in the bottom half of all states in both prematurity and infant mortality. While effective interventions are used in Ohio, they are not used consistently, says Edward Donovan, M.D., a neonatologist at Cincinnati Children’s Hospital Medical Center and co-chair of the executive committee of the OPQC.

“We want to take the evidence-based research that already exists and apply it throughout the state to ensure the best possible outcomes for mothers and their babies,” he says.

Since its inception in 2007, the OPQC has focused primarily on two quality improvement projects. In addition to reducing infections in newborn intensive care units, providers have been working on reducing “unwarranted” late-term births -- infants delivered between 36 and 38 weeks without a medical reason to deliver them early. These are babies who would be healthier if they were delivered at term.

With these two projects, the OPQC has prevented more than 8,000 late preterm and near-term births and saved approximately $20 million in health care costs for the state of Ohio.

The OPQC was initially funded by the Ohio Department of Jobs and Family Services to develop the quality improvement collaborative, including setting up a data system and supporting systems of care throughout the state. Twenty-two states applied for project funding through the federal Centers for Medicare and Medicaid Services, and Ohio was the only state to be awarded funding.

Dr. Donovan co-chairs the executive committee with Jay Iams, MD, a physician at The Ohio State University Medical Center. In addition to 44 OB and NICU teams across the state, partners include the Ohio Department of Health, Ohio’s six regional perinatal centers, the Ohio Department of Job and Family Services, Barbara Rose, RN, MPH, is program director.

About Cincinnati Children's

Cincinnati Children's Hospital Medical Center is one of just eight children's hospitals named to the Honor Roll in U.S. News and World Report's 2010-11 Best Children's Hospitals. It is ranked #1 for digestive disorders and highly ranked for its expertise in pulmonology, cancer, neonatology, heart and heart surgery, neurology and neurosurgery, diabetes and endocrinology, orthopedics, kidney disorders and urology. Cincinnati Children's is one of the top two recipients of pediatric research grants from the National Institutes of Health. It is internationally recognized for quality and transformation work by Leapfrog, The Joint Commission, the Institute for Healthcare Improvement, the federal Agency for Healthcare Research and Quality, and by hospitals and health organizations it works with globally. Additional information can be found at www.cincinnatichildrens.org.