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  • Quality Improvement Article
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A multidisciplinary quality improvement effort to reduce bronchopulmonary dysplasia incidence

Journal of Perinatology volume 40, pages 681–687 (2020)Cite this article

Subjects

Abstract

Background

Bronchopulmonary Dysplasia (BPD) is the most common prematurity complication. Although several practices have been proposed for BPD prevention, none of these in isolation prevent BPD.

Methods

Our initiative focused on two key drivers: oxygen management and noninvasive ventilation strategies. We created best practice guidelines and followed outcome measures using Shewhart control charts.

Results

PDSAs of protocols preceded a large-scale rollout of a “0.21 by 28” campaign in 2014 leading to a special cause reduction in the “any BPD” rate, and a decrease in severe BPD (from 57 to 29%). At the end of 2017, we reinvigorated the project, which led to dramatic decreases in the “any BPD” rate to 41% and the “severe BPD” rate to 21%.

Conclusions

A multidisciplinary QI initiative focused on process improvement geared towards the pathophysiological contributors of BPD has successfully reduced the rate of BPD in an all referral level IV NICU.

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Fig. 1: p control chart showing percent of babies in cohort population requiring oxygen on day-of-life 28.
Fig. 2: p control chart showing percent of babies with any BPD at 36 weeks corrected gestational age.
Fig. 3: p control chart showing percent of babies in cohort population with severe BPD at 36 weeks corrected gestational age.
Fig. 4: Number of CPAP days (blue bars), ETT days (red bars) and ratio of CPAP to ETT days (green line), by year.

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Author information

Authors and Affiliations

  1. Division of Neonatology, Nationwide Children’s Hospital, Columbus, OH, USA

    Roopali Bapat, Leif Nelin, Edward Shepherd & Thomas Bartman

  2. Research Institute and Center for Perinatal Research, Nationwide Children’s Hospital, Columbus, OH, USA

    Leif Nelin

  3. Nationwide Children’s Hospital, Columbus, OH, USA

    Greg Ryshen & Amee Elgin

Authors
  1. Roopali Bapat
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  2. Leif Nelin
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  3. Edward Shepherd
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  4. Greg Ryshen
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  5. Amee Elgin
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  6. Thomas Bartman
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Contributions

RB, ES, LN, GR, and TB conceptualized and designed the study, coordinated and supervised data collection, drafted the initial manuscript, and reviewed and revised the manuscript. AE designed the data collection instruments, collected data, carried out the initial analyses, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Thomas Bartman.

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The authors declare that they have no conflict of interest.

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Bapat, R., Nelin, L., Shepherd, E. et al. A multidisciplinary quality improvement effort to reduce bronchopulmonary dysplasia incidence. J Perinatol 40, 681–687 (2020). https://doi.org/10.1038/s41372-019-0574-8

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