Raising the bar for neonatal care in northeast Ohio

Rita Vitale

Rita Vitale

Akron Children’s Hospital’s neonatal team is continuously working to improve patient care through the Vermont Oxford Network (VON), Child Health Corporation of America (CHCA) and the Ohio Perinatal Quality Neonatal (OPQC-NEO) collaborative.

Over the past 15 years, Akron Children’s NICU, nationally recognized for its outcome data, has reduced the occurrence of 12 major complications in neonates to well below national averages, while surpassing the survival rate for infants born between 22 and 29 weeks gestation compared to VON and CHCA averages.

The measure of success

One major success has been a reduction in the number of blood stream infections, which affects about 30 percent of extremely low-birth-weight babies nationwide.

In 2011, Akron Children’s NICU went 218 days without a blood stream infection, and the rate of catheter-associated blood stream infections decreased from 1.7 percent in 2010 to 0.8 percent in 2011. The NICU also outperformed the OPQC-NEO goal of reducing line-associated late bacterial infections by 50 percent.

RN Satisfaction

RN Satisfaction

These decreased complications have dramatically reduced hospitalization costs as each infection adds about two weeks and $40,000 to a NICU stay.

“We look for areas where we can improve and set targets based on national benchmarks,” said Judy Ohlinger, MSN, RNC-NIC, performance improvement and research coordinator in the NICU. “We examine best practice evidence to accomplish our goals and use a systematic approach to make changes. These targets are always moving.”

Our results have also attracted the attention of other facilities.

“People come to us to learn how we did it,” said Anand Kantak, MD, director of Neonatology. “We tell them that it encompasses the whole culture, from the administration and board down to the support staff and everyone in between.”

Another success is the Ohio Perinatal Quality Obstetrics (OPQC-OB) collaborative to eliminate electivenear-term and late-preterm births in Ohio.

Akron Children’s Division of Maternal Fetal Medicine participated in this Ohio-based network of perinatal care providers working to improve neonatal and perinatal outcomes. They tackled the challenge of reducing the high rate of preterm births in Ohio and the associated infant morbidities.

Since 1990, preterm birthrates have risen in Ohio and the U.S. almost entirely due to a steady increase in late-preterm births.

Team member Dana Nelson, MSN, CNS, clinical manager, Maternal Fetal Medicine, reported that the collaborative met its goal within one year – to reduce by 60 percent the number of women in Ohio at 36.0 to 38.6 weeks gestation for whom initiation of labor or caesarean section is done electively, in the absence of appropriate medical or obstetric indication – with the ultimate goal of eliminating avoidable late-preterm and near-term births that require NICU care. The rate declined from 25 percent to less than 1 percent in the 20 participating hospitals.

Raising the bar for neonatal care
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