Case Study

CHOI Standardizes Care during Transport for <32 Week Infants

In 2019, VON launched an internet-based quality improvement collaborative focused on improving care during transitions. Faculty encouraged teams to identify areas of the admission or discharge process for improvement and provided a toolkit, VON Day Audit for gap analysis, and sample process measures to help teams focus their improvement work.

“We felt good about our outcomes but we always know there are ways we can improve,” said Denise Cornell, APRN, from Children’s Hospital of Illinois (CHOI). “The experience in this collaborative made us look deeper into what we were doing.”

“It was helpful to have the VON toolkit and gap analysis early on to help us find where we could potentially see improvement, and then use the tools VON provided to help improve our process measures and outcomes,” said Aarti Amlani, MD.

By looking at their VON data, the CHOI team found infants born at less than 32 week gestational age at a referral center had greater mortality and morbidity rates than infants born at less than 32 week gestational age in their center. They decided to focus improvement efforts on the process of transports.

VON's QI collaborative for Critical Transitions

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More than a sum of parts

Their first goal was to decrease departure time for the transport team.

A multidisciplinary team including nurses, respiratory therapists, neonatologists, the ambulance company, and medical communications met weekly. Each group found small actions they could take to cut a few minutes from the departure process.

“We’re looking comprehensively at all areas to improve overall outcomes, and we find it’s always about the little things,” said Cornell.

Those many small actions added up, and the team has since met their goal of at least 80 percent of departures leaving within 30 minutes of the call.

“We felt good about our outcomes but we always know there are ways we can improve. The experience in this collaborative made us look deeper into what we were doing.”

Standardizing care throughout referral network

The team’s other goal was to decrease morbidities, including ROP, IVH, and CLD, in outborn infants less than 32 weeks gestation.

“We knew we wouldn’t improve without engaging our referral network to improve and standardize care,” said Elaine Shafer, APRN, the perinatal outreach coordinator at CHOI.

The team distributed guidelines to referring hospitals about delayed cord clamping, respiratory care, and temperature. They also sought to engage colleagues in obstetrics to standardize care in the antenatal period.

“It’s important to think about this project from a mother-baby perspective. We know antenatal care affects infant outcomes so we’re making efforts to standardize application of magnesium sulfate and steroids, and use antibiotics most appropriately,” said Shafer. “We hope to see these efforts impact longer term outcomes.”

Empowering parents during transport

The CHOI team is also seeing the benefit of engaging parents early in the process. A CHOI neonatologist speaks with the parents before they leave the referring hospital, which helps reinforce their understanding and makes them feel more empowered.

“One of the things we’re doing is having the mother pump colostrum that we can swab in the baby’s mouth, and the mother knows that she did something to help her baby nutritionally and infection-wise before they’re transferred away,” said Cheryl Lopeman, RN.

CHOI improvement poster from 2019 Annual Quality Congress

CHOI improvement poster from the 2019 Annual Quality Congress

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Collaborative support for improvement

The CHOI team believes the best way to serve their patients and families is to look at their data and strive to improve.

The challenge can seem daunting at first because there are so many transitions during the course of care where teams can focus improvement. The CHOI team addressed this challenge by making use of the tools available to them through VON and connecting with other teams in the collaborative over the listserv and in person at the Annual Quality Congress to see how others were improving their transport processes.

“This is my first year as an active member of the VON team. I admit I thought, ‘How are we going to do all these things?’ but then I realized we can focus on the small things,” said Cornell. “We can look at temperature, see it can be improved, then make changes to improve the baby’s temperature during transport. That’s not hard to do; that’s easy to do. You just have to get involved.”