Table 1 Examples of QI papers published from each of the 5 collaboratives.

 1

Interdisciplinary Teamwork and the Power of a Quality Improvement Collaborative in Tertiary Neonatal Intensive Care Units [25]

Establish a collaborative infrastructure and reduce central line-associated bloodstream infections (CLABSIs)

Enable completion of meaningful, collaborative QI projects in the CHNC CIQI by achieving targets set on measures

Grover T/2015

17

CLABSI rate decreased from 1.33/1000 line days to a rate of 1.08/1000 line days, a 20% decrease.

11 of the 17 centers showed improvement. The improvement was sustained for 12 months.

 2

SLUG Bug: Quality Improvement With Orchestrated Testing Leads to NICU CLABSI Reduction [35]

Reduce central line–associated bloodstream infection (CLABSI)

Decrease collaborative baseline CLABSI rates by a clinically meaningful target of 15% over 12 months

Piazza A/2016

17

14 of the 17 centers had decreased infection rates.

Orchestrated testing showed that Hub scrub compliance monitoring in combination with sterile tubing change, had the strongest effect in decreasing CLABSI rates.

 3

Sustaining SLUG Bug CLABSI Reduction: Does Sterile Tubing Change Technique Really Work? [36]

Sustain CLABSI rates and assess the impact of the sterile tubing change (TC) technique as a component in CLABSI reduction

(1) report the ability of centers to sustain low rates and (2) describe the impact of the change from clean to sterile TC techniques in the 4 centers over the subsequent months of the sustain phase beginning in January of 2013

Pallotto EK/ 2017

16

The 19.3% collaborative CLABSI rate reduction was sustained for the subsequent 19 months.

Four centers adopted the sterile TC technique during the sustain phase and had a 64% fall in CLABSI rates.

 4

STEPP IN: Working Together to Keep Infants Warm in the Perioperative Period [55]

Collaboration between Neonatology and Anesthesia for perioperative temperature management in Neonates

Decrease the incidence of hypothermia by 50%, from a baseline of ∼20% to 10%, by December 2014 and sustain over 12 months.

Brozanski/2020

19

Postoperative hypothermia decreased by 48%, from a baseline of 20.3% to 10.5% .

 5

STEPP IN: A Multicenter Quality Improvement Collaborative Standardizing Postoperative Handoffs [56]

Collaboration between Neonatology and Anesthesia for postoperative communication

Handoff improvement to reduce care failures by 30% and implement a standardized communication process for postoperative handoff.

Piazza A/2021

19

Communication failures specific to respiratory care decreased by 73.2%. All other communication care failures decreased by 49.4%.

 6

A Multicenter Collaborative to Improve Postoperative Pain Management in the NICU [53]

Decrease postoperative pain and improve family satisfaction with pain management

Decrease the percentage of patients with unrelieved postoperative pain from 19.5% to 15% or less and improve family satisfaction with pain management to ≥90% in the first 24-hours postop. Sustain the improvement for 6 months

Bapat R/2023

23

The percentage of patients with unrelieved pain decreased by 35% from 19.5% to 12.6%. Family satisfaction with pain management increased from 93% to 96%. Improvements maintained during sustain period.

 1

Children’s Hospitals’ Solutions for Patient Safety Collaborative Impact on Hospital-Acquired Harm [57]

To determine if reliable best practice implementation and culture of safety improvements can reduce hospital-acquired conditions (HACs) and serious safety events (SSEs).

The team for each of the 9 HACs developed their own specific aim along with a target of 90% compliance to the bundles.

Lyren, A/2017

32 sites for HACs and 21 for SSEs

Significant harm reduction occurred in 8 of 9 common HACs (range 9%–71%; P < 0.005 for all). The mean monthly SSE rate decreased 32% (from 0.77 to 0.52; P < 0.001).

 2

Impact of a Pressure Injury Prevention Bundle in the Solutions for Patient Safety Network [58]

To describe changes in pressure injury (PI) rates in pediatric hospitals after implementation of an active surveillance and prevention bundle and to assess the impact of bundle elements.

To reduce the number of serious PI defined as stage 3, stage 4, unstageable pressure injuries, and deep tissue injuries

Frank, G/2017

33

The rate of stage 3 PI declined from 0.06 to 0.03 (P < 0.001), stage 4 pressure injuries declined from 0.01 to 0.004 per 1000 patient-days (P = 0.02). The cohort that achieved 80% prevention bundle compliance had significantly lower PI rates.

 3

Assessment of an Unplanned Extubation Bundle to Reduce Unplanned Extubations in Critically Ill Neonates, Infants, and Children [59]

To determine if a QIC initiative targeting all intubated neonatal and pediatric patients is associated with a reduction in UEs and morbidity associated with UE events.

To reduce the absolute rate of UEs to < 1UE/100 ventilator days over a 2-year period

Klugman, D/2020

43

Aggregate reduction in UE events by 24.1%, from a baseline rate of 1.135 UEs to 0.862 UEs per 100 ventilator days. Pediatric ICU showed an absolute reduction in UE events of 20.6% and neonatal ICU demonstrated 17.6% reduction.

 4

The Relationship between High-reliability practice and Hospital-acquired conditions among the SPS Collaborative [60]

Evaluating the association between integrating high-reliability practices and patient harms to inform a patient safety strategy across the healthcare landscape

To evaluate the association between high-reliability practices and hospital-acquired conditions

Randall, K/ 2021

25

In this nonexperimental design study, there was a significant inverse relationship between the culture of safety component score and the Serious Harm Index (p < 0.03) indicating that integration of high-reliability principles may support improved patient safety.

 5

Association Between Hospital-Acquired Harm Outcomes and Membership in a National Patient Safety Collaborative [61]

Understand the true effect of large-scale, government-funded collaborative improvement programs to guide policy and practice around health care improvement.

To evaluate associations between membership in SPS and hospital-acquired harm using standardized definitions and secular trend adjustment.

Coffey M/ 2022

99

Comparing early adopters to late adopters, implementation of the SPS was associated with an improvement in HAC rates in 3 of the 8 conditions: central catheter–associated bloodstream infections, falls of moderate or greater severity, and adverse drug events.

 6

Pediatric Ventilator-Associated Events Before and After a Multicenter Quality Improvement Initiative [62]

To assess whether adherence to 1 or more test factors in a QI bundle would reduce PedVAE rates.

Decrease the PedVAE rate by 20% by December 2020

Wu AG/2023

95

PedVAEs prevention QI bundle decreased the rate by 26% in hospitals that received training and education. In hospitals that did not implement such interventions, improvement was not noted.

 1

Lessons Learned from Hospital Leaders Who Participated in a National Effort to Improve Maternity Care Practices and Breastfeeding [63]

A national QI collaborative of hospital leaders designed to accelerate the number of Baby-Friendly–designated hospitals focused on maternity care practices and breastfeeding.

To have an additional 90 hospitals in the United States designated as Baby-Friendly

Feldman-Winter L/ 2016

89

Leadership QI training served as a vital catalyst resulting in 89 newly designated Baby-Friendly hospitals.

 2

Best Fed Beginnings: A Nationwide Quality Improvement Initiative to Increase Breastfeeding [64]

To increase breastfeeding and achieve Baby-Friendly designation

By September 30, 2014, 100% of the participating hospitals are designated as Baby-Friendly or have a BFUSA site visit scheduled

Feldman-Winter L/ 2017

90

80% of hospitals received the Baby-Friendly designation. Breastfeeding increased from 79% to 83%, and exclusive breastfeeding increased from 39% to 61%.

 3

Maternity Care Clinicians’ Experiences Promoting Infant Safe Sleep and Breastfeeding During the COVID-19 Pandemic [41]

Clinicians’ perceptions and experiences of promoting infant safe sleep (ISS) and breastfeeding during the COVID-19 pandemic

No prespecific aim mentioned

Menon M/ 2023

10

Descriptive qualitative study of 29 clinicians from 10 hospital teams. Key informant interviews identifies 4 main themes: Strain on Clinicians Related to Hospital Policies, Coordination, and Capacity; Effects of Isolation for Parents in Labor and Delivery; Reevaluating Outpatient Follow-Up Care and Support; Adopting Shared Decision-Making.

 1

Improving Growth of Very Low Birth Weight Infants in the First 28 Days [65]

Improving neonatal growth

To increase weight gain in the first 28 days after birth for very low birth weight (VLBW) infants

Bloom BT/ 2003

51

Average daily weight gain increased from 10.4 ± 6 g to 12.5 ± 6 g. 76% units noted improvement.

 2

Comprehensive Oxygen Management for the Prevention of Retinopathy of Prematurity: The Pediatrix Experience [66]

Development of Electronic Health Records, tools for QI initiatives and examples of QI initiatives (COMP-ROP (Comprehensive Management of ROP)

The COMP-ROP Collaborative- no prespecific aim mentioned

Ellsbury D/ 2010

80

A decrease in severe ROP (stage 3, 4, 5, or surgical) in infants with birth weights of 400 to 1500 g from 11% to 5.8%.

 3

A Multifaceted Approach to Improving Outcomes in the NICU: The Pediatrix 100 000 Babies Campaign [67]

Generate large-scale simultaneous improvements in multiple domains of care in a large neonatal network.

Improve performance in targeted process and outcome measures by 10% by 2013

Ellsbury D/ 2015

330

Human milk feeding, exposure to medications that were targeted for reduction (dexamethasone, H2 blockers, metoclopramide, and cefotaxime), ventilator days, admission temperature all improved (p < 0.0001). Mortality, necrotizing enterocolitis, retinopaty of prematurity, late onset sepsis, and CLABSI all decreased. Survival without significant morbidity improved.

 1

Collaborative Quality Improvement for Neonatal Intensive Care [16]

To make measurable improvements in infection and chronic lung disease outcomes using a multidisciplinary QIC model.

Reduction in the nosocomial infection rate for infants 501 to 1500 g to the 25th percentile and absolute reduction in the rate of death or oxygen supplementation at 36 weeks’ postconceptional age by 10% for infants 501 to 1000 g with gestational ages < 34 weeks.

Horbar, J/ 2001

10

The rate of infection with coagulase-negative staphylococcus decreased from 22.0% to 16.6% (p = 0.007)and death or supplemental oxygen at 36 weeks’ adjusted gestational age decreased from 55.9% to 47.6% (p = 0.039). There was heterogeneity in the effects among the NICUs in both project groups.

 2

Economic Implications of Neonatal Intensive Care Unit Collaborative Quality Improvement (NIC/Q) [50]

To describe the economic implications of a collaborative QI effort for very low birth weight infants in the NIC/Q.

Data on treatment costs and data on resources were collected.

Rogowski, J/2001

10

The median treatment cost per infant with birth weight 501 to 1500 g in the infection group decreased from $57,606 to $46,674 (p < 0.0001); at the 4 chronic lung disease hospitals decreased from $85,959 to $77,250 (p = 0.7980).

 3

Improving Care for Neonatal Abstinence Syndrome (NAS) [68]

To determine if the collaborative was effective in standardizing hospital policies and improving patient outcomes for infants with NAS.

A multicenter, multistate QIC focused on infants requiring pharmacologic treatment for NAS.

Patrick, S/ 2016

199

NAS focused guidelines increased. The median length of pharmacologic treatment decreased from 16 days to 15 days (P = 0.02), and LOS from 21 days to 19 days (P = 0.002). Fewer babies, 39.7% vs. 26.5%, wnet home of medication (p = 0.02)

 4

Alarm safety and oxygen saturation targets in the VON iNICQ 2015 collaborative [69]

Prospective multicenter audits assessed implementation of policies addressing Joint Commission 2014 Alarm Safety goals

To assess progress in VON iNICQ 2015: Alarm Safety Collaborative in achieving Joint Commission 2014 alarm safety goals with respect to oximeters, and to compare patient-level oxygen saturation (SpO2) and oximeter alarm data to local policies.

Hagadorn, JI/ 2017

86

Of 13 policies addressing mandated goals, 8 policies were implemented at audit 1 and 9 at audit 2 (P = 0.004). At audit 1, 28 NICUs had implemented ⩾ 9 policies versus 47 at audit 2. Median SpO2 target lower limit was 88% (interquartile range 87%, 90%; range 75%–94%), upper limit 95% (interquartile range 94%, 96%; range 85%–100%).

 5

A Collaborative Multicenter QI Initiative to Improve Antibiotic Stewardship in Newborns [70]

Achieve increased compliance with the Centers for Disease Control and Prevention (CDC) core elements for antibiotic stewardship and demonstrate reductions in antibiotic use (AU) among newborns

To assess the progress of the participating NICUs with respect to achieving the CDC core elements of antibiotic stewardship and measure the AUR over the 2 years of this collaborative. Individual teams were encouraged to develop SMART aim statements

Dukhovny D/2019

146

The percentage of NICUs implementing the CDC core elements increased in each of the 7 domains. The median AU rate decreased from 16.7% to 12.1% (p < 0.0013), a 34% relative risk reduction.

 6

Implementing an exclusive human milk diet for preterm infants: real-world experience in diverse NICUs [71]

Human milk–based human milk fortifer (HMB-HMF) makes it possible to provide an exclusive human milk diet (EHMD) to very low birth weight (VLBW) infants in NICU.

Increase the utilization of an EHMD in the NICU population

Swanson, J/2023

7

EHMD programs were cost effective. EHMD programs resulted in either a decrease or change in total (medical+surgical) NEC rate and reductions in surgical NEC. Institutions that provided cost and complications data reported a substantial cost avoidance after EHMD implementation, ranging between $515,113 and $3,369,515 annually per institution.