This document describes the Pediatrix Clinical DataWarehouse and its role in quality improvement initiatives for neonatal medicine. The Clinical DataWarehouse contains clinical data on over 700,000 patients and is one of the largest databases for neonatal outcomes. Data from electronic medical records is extracted and analyzed to identify areas for improvement. Quality improvement projects are developed and tracked using the QualitySteps system. Analyzing outcomes data allows Pediatrix to benchmark performance and drive continuous quality improvement that improves patient care.
Getting started at the national level from demonstration to spreadProqualis
Apresentação de Derek Freeley durante o SIMPÓSIO EINSTEIN-IHI: Implantação e Disseminação de Programas de Segurança do Paciente aconteceu de 3 a 5 de novembro de 2013, em São Paulo - Brasil.
Derek Freeley é Vice Presidente Executivo do Institute for Healthcare Improvement (IHI), tem responsabilidades executivas por conduzir estratégias do IHI em cinco áreas de atuação: desenvolvimento de habilidade; cuidado centrado no paciente e família; segurança do paciente; qualidade; custo e valor; e grande foco em populações. Antes de integrar a equipe do IHI em 2013, foi diretor geral de saúde e assistência social e diretor executivo do National Health Service (NHS) na Escócia.
Ancillary Revenue Program - Are you still sending out these tests to an outside lab? UTI/STI • Vaginitis • Respiratory • ENT/Sinus • Wound • GI related infections. Find out how to CAPTURE OUTSIDE LAB REVENUE and improve patient experience and outcomes. (8) tests a day generates you over $30K in bottom-line revenue & advances patient care with a 1-hour test result that includes antibiotic resistance read-out.
https://optimalhealthadvocates.com/
UROLOGY • OB/GYN • INTERNAL MEDICINE • PRIMARY CARE • URGENT CARE • PEDIATRICS • ENT/ALLERGY • WOUND CARE
PROVEN PROGRAM:
✅ Over 100 Established Locations across the United States -- each generating at least $30K/month in bottom-line revenue.
✅ ELIMINATE delayed or ineffective antibiotic treatment & costly last-minute surgery cancellations (1-hour turn-around for results with antibiotic resistance read-out);
✅ Keep your providers compliant with CDC Antibiotic Stewardship Program (that is soon to be mandated in the clinical setting) with our program's monthly reports that will increase your facility health score by showing you are reducing the use of unnecessary antibiotics with PCR testing that is 96% more accurate than a traditional culture.
We handle ALL of the upfront capital costs, billing, staffing, and CLIA licensure/compliance at NO UPFRONT COST TO THE PRACTICE -- All that’s required is a 6-foot workspace to run the tests.
To LEARN MORE and SEE IF YOUR PRACTICE QUALIFIES, Book a 10-min Discovery Call with Jen here:
https://go.oncehub.com/Advanced_In-Office_PCR_Lab_Discovery-Call
Optimal Health Advocates as an Ancillary Medical Practice Revenue Generation company helping medical practices capture significant revenue increases while improving patient lives and outcomes.
--------------
Jennifer Anderson is a 20-year Practice Manager, entrepreneur, and digital marketing expert who intimately understands the challenges of the business of medicine and is passionate about helping Medical Sales Companies and Medical Practices successfully implement systems and services that enhance and save patient lives and increase practice revenue.
Kate Silvester, a healthcare systems engineer, discusses the challenges of working with data and statistical techniques for real-time monitoring of care quality.
Apresentação de Derek Freeley durante o SIMPÓSIO EINSTEIN-IHI: Implantação e Disseminação de Programas de Segurança do Paciente aconteceu de 3 a 5 de novembro de 2013, em São Paulo - Brasil.
Derek Freeley é Vice Presidente Executivo do Institute for Healthcare Improvement (IHI), tem responsabilidades executivas por conduzir estratégias do IHI em cinco áreas de atuação: desenvolvimento de habilidade; cuidado centrado no paciente e família; segurança do paciente; qualidade; custo e valor; e grande foco em populações. Antes de integrar a equipe do IHI em 2013, foi diretor geral de saúde e assistência social e diretor executivo do National Health Service (NHS) na Escócia.
Find eligible patients that fit your protocol faster, identify and secure proven and/or new sites, forecast and measure progress more efficiency. With Covance's proprietary data, your program hits its mark.
Getting started at the national level from demonstration to spreadProqualis
Apresentação de Derek Freeley durante o SIMPÓSIO EINSTEIN-IHI: Implantação e Disseminação de Programas de Segurança do Paciente aconteceu de 3 a 5 de novembro de 2013, em São Paulo - Brasil.
Derek Freeley é Vice Presidente Executivo do Institute for Healthcare Improvement (IHI), tem responsabilidades executivas por conduzir estratégias do IHI em cinco áreas de atuação: desenvolvimento de habilidade; cuidado centrado no paciente e família; segurança do paciente; qualidade; custo e valor; e grande foco em populações. Antes de integrar a equipe do IHI em 2013, foi diretor geral de saúde e assistência social e diretor executivo do National Health Service (NHS) na Escócia.
Ancillary Revenue Program - Are you still sending out these tests to an outside lab? UTI/STI • Vaginitis • Respiratory • ENT/Sinus • Wound • GI related infections. Find out how to CAPTURE OUTSIDE LAB REVENUE and improve patient experience and outcomes. (8) tests a day generates you over $30K in bottom-line revenue & advances patient care with a 1-hour test result that includes antibiotic resistance read-out.
https://optimalhealthadvocates.com/
UROLOGY • OB/GYN • INTERNAL MEDICINE • PRIMARY CARE • URGENT CARE • PEDIATRICS • ENT/ALLERGY • WOUND CARE
PROVEN PROGRAM:
✅ Over 100 Established Locations across the United States -- each generating at least $30K/month in bottom-line revenue.
✅ ELIMINATE delayed or ineffective antibiotic treatment & costly last-minute surgery cancellations (1-hour turn-around for results with antibiotic resistance read-out);
✅ Keep your providers compliant with CDC Antibiotic Stewardship Program (that is soon to be mandated in the clinical setting) with our program's monthly reports that will increase your facility health score by showing you are reducing the use of unnecessary antibiotics with PCR testing that is 96% more accurate than a traditional culture.
We handle ALL of the upfront capital costs, billing, staffing, and CLIA licensure/compliance at NO UPFRONT COST TO THE PRACTICE -- All that’s required is a 6-foot workspace to run the tests.
To LEARN MORE and SEE IF YOUR PRACTICE QUALIFIES, Book a 10-min Discovery Call with Jen here:
https://go.oncehub.com/Advanced_In-Office_PCR_Lab_Discovery-Call
Optimal Health Advocates as an Ancillary Medical Practice Revenue Generation company helping medical practices capture significant revenue increases while improving patient lives and outcomes.
--------------
Jennifer Anderson is a 20-year Practice Manager, entrepreneur, and digital marketing expert who intimately understands the challenges of the business of medicine and is passionate about helping Medical Sales Companies and Medical Practices successfully implement systems and services that enhance and save patient lives and increase practice revenue.
Kate Silvester, a healthcare systems engineer, discusses the challenges of working with data and statistical techniques for real-time monitoring of care quality.
Apresentação de Derek Freeley durante o SIMPÓSIO EINSTEIN-IHI: Implantação e Disseminação de Programas de Segurança do Paciente aconteceu de 3 a 5 de novembro de 2013, em São Paulo - Brasil.
Derek Freeley é Vice Presidente Executivo do Institute for Healthcare Improvement (IHI), tem responsabilidades executivas por conduzir estratégias do IHI em cinco áreas de atuação: desenvolvimento de habilidade; cuidado centrado no paciente e família; segurança do paciente; qualidade; custo e valor; e grande foco em populações. Antes de integrar a equipe do IHI em 2013, foi diretor geral de saúde e assistência social e diretor executivo do National Health Service (NHS) na Escócia.
Find eligible patients that fit your protocol faster, identify and secure proven and/or new sites, forecast and measure progress more efficiency. With Covance's proprietary data, your program hits its mark.
A standards-based approach to development of clinical registries - Initial lessons learnt from the gestational diabetes registry. Presented by Koray Atalag, National Institute for Health Innovation, University of Auckland, at HINZ 2014, 12 November 2014, 12pm, Plenary Room 2
A Standards-based Approach to Development of Clinical Registries - Initial Le...Koray Atalag
This is the prezo I presented at HINZ 2014 conference.
Gestational diabetes has implications for both mother and child with risk of complications during pregnancy, and type 2 diabetes later in life. This paper presents the initial lessons learned from the development of a clinical registry. The aims of the Registry are: 1) 100% successful diabetes screening within 3 months of delivery; 2) Annual type 2 diabetes screening; 3) Early warning in subsequent pregnancies.
We have employed the openEHR standard which underpins our national interoperability reference architecture to represent the dataset and also to build the web-based registry system. Use of this rigorous methodology to tackle health information is expected to ensure semantic consistency of Registry data and maximise interoperability with other Sector projects. The development work has been facilitated by the ability to transform the dataset automatically into software code – ensuring clinical requirements accurately translated into technical terms.
Dataset has been finalised, registry system has been developed and deployed for pilot implementation. Data entry is underway for participants after consenting.
This registry is expected to increase the screening of women leading to earlier detection of diabetes. It should provide a valuable picture of the condition and is intended for extension and wider roll-out after evaluation.
Cognitive Computing: Company presentation by Avner Halperin, Co-Founder & CEO of EarlySense at the NOAH Conference 2019 in Tel Aviv, Hangar 11, 10-11 April 2019.
Registry Participation 101: A Step-by-Step Guide to What You Really Need to K...Wellbe
– Is your hospital contemplating joining a registry but you don’t know where to begin?
– Do the acronyms CJR, QCDR, and PROMs cause you angst?
– Have you heard that registry participation can count towards quality programs but you don’t understand the connection?
– Are you a surgeon needing a registry to meet Meaningful Use requirements?
– Are you in one of the 67 geographical areas mandated by the CMS’s Comprehensive Care for Joint Replacement (CJR) program?
– Is your hospital considering a patient-reported outcome measure (PROMs) program and you want to know more about what that entails?
If so, the American Joint Replacement Registry (AJRR) will walk you through everything you need to know about participating in a registry. This session will focus on best practices from over 4,500 surgeons and 675+ hospitals who have successfully implemented and engaged with the data from over 400,000 hip and knee replacement procedures. AJRR will help you to debunk the myth that submitting private health information is complicated, time consuming, and that it takes hundreds of man-hours to participate in a registry.
You’ll also learn how:
• Registry participation can support mandated quality programs – including Meaningful Use, CJR, and PQRS
• To implementing a PROM system in your hospital – what to look out for when starting and helpful tips from current users on what they have learned
• Not all data elements are mandatory – what are the different levels, what does the national registry require, and what is optional
About the Speakers:
Joe Greene is currently the Program Manager of Outreach and Development for the University of Wisconsin Hospital and Clinics in the Department of Orthopedics and Rehabilitation. In this role, Joe coordinates business and philanthropic development activities for the UW Hospital department and University of Wisconsin Department of Orthopedics and Rehabilitation. He represents the needs of all orthopedic subspecialties and has worked for the UW since 1991 when he initiated his career there as an athletic trainer and clinician. He has worked in management and administration across the Department since 1997.
In addition to his role with the UW Hospital, Joe also is the CEO and Owner of OrthoVise. OrthoVise is an Orthopedic advisory firm that assists orthopedic practices of all types with operational and business development needs. His experiences have allowed him and his advisors the opportunity to consult formally with orthopedic practices since 2010. He has particular areas of interest that include Orthopedic and Sports Medicine Program Business Development, Service Line Development, Health Information Technology and EMR Operational Optimization for Orthopedics, Innovative Service Delivery Implementation, Smart Staffing, and Workflow Enhancement.
Joe will be joined by AJRR staff who are experts in guiding individual surgeons and hospital orthopaedic service line directors through the process.
Aldo Rolfo, National Clinical Development Manager, Genesis Cancer Care, Austr...GenesisCareUK
A program that seeks to redefine best practice across the drivers of the GenesisCare business (Quality, Access and Efficiency) in order to deliver on their vision of “Innovating Healthcare. Transforming Lives.”
Optimising the Model of Care for Patient Management at The Tweed Cancer Care ...Cancer Institute NSW
The commonly understood model of shift to shift nursing handover does not apply to most ambulatory day treatment units. Nonetheless, ‘handover’ of patient clinical information remains quintessential to safe clinical practice. Of considerable interest is how EMR may aid the transfer of patient clinical information in these circumstances and address the question: does this facilitate improved patient care?
Case Study “Investment in a Health IT Infrastructure, the Future Quality Imperative”
Steven Anderman
Chief Operating Officer & SVP, Operations
Bronx-Lebanon Hospital Center
MeHI Regional Health IT Meetings - Worcester, MA - Nov, 2013MassEHealth
Presentation from the Massachusetts eHealth Institute Regional Health IT meeting in Worcester, MA in November, 2013. Featuring Larry Garber from Reliant Medical Group.
MeHI Regional Health IT Meetings - Worcester, MA - Nov, 2013
Spitzer datawarehouse
1. The Pediatrix Clinical DataWarehouse and
The 100,000 Babies Campaign—Tools for
Quality Improvement in Neonatal Medicine
2. NICU
Peri Practice
PICU
Ped Hospitalists
Ped Cardio Practice
Anesthesia Practice
Regional Office
Headquarters
09.20.09
Southern CA
16 NICUs, 2 PICUs 2
OBX, 3 Hosp. Prgm.
Denver
10 NICUs, 1 OBX, 3 PICUs
1 Cardi & 2 Hosp. Prog.
South FL
7 NICUs, 2 PICUs
4 Cardi & 1 Hosp. Prog.
Puerto Rico
9 NICUs & 5 PICUs
Dallas-Ft. Worth
27 NICUs, 2 Cardi
3 OBX & 3 Hosp. Prog.
Houston
11 NICUs & 1 OBX
Austin
10 NICUs, 1 Cardi
1 OBX & 2 Hosp. Prog.
San Antonio
9 NICUs, 1 OBX
& 1 Cardi
El Paso
5 NICUs
& 1 CardiPhoenix
4 NICUs, 1 Cardi
& 1 OBX
Oklahoma City
8 NICUs
Seattle/Tacoma
14 NICUs, 1 Cardi
1 PICU & 3 OBX
Chattanooga
3 NICUs
Las Vegas
6 NICUs, 2 PICUs,
& 2 Hosp. Prgm.
San Jose
3 NICUs, 1 OBX, 1 PICU
& 1 Hosp. Prog.
Tampa
6 NICUs, 1 Cardi
& 1 OBX
Kansas City
3 NICUs & 1 OBX
McAllen-Harlingen
6 NICUs
Atlanta
9 NICUs, 1 PICU
4 OBX & 1 Anesth Pr.
Charlotte
4 NICUs
Columbia
3 NICUs
Dayton
4 NICUs
Wash. DC
7 NICUs
1 Cardi &
1 Anesth Pr.
Greenville
3 NICUs
Knoxville
4 NICUs
Central FL
6 NICUs & 1 Cardi
San Francisco
4 NICUs
Akron
3 NICUs
Cleveland
3 NICUs
Nashville
9 NICUs
Ped ER
3. 3
YTD 2010
> 275 Hospital NICUs
ADC 4,500-4,600
> 90,000 NICU admissions annually
Covering approximately 22% NICU patients nationally
EHR (BabySteps) present in approximately 90% of the NICUs
Active participation of NICUs in our CQI projects and outcomes
metrics
5. CENTER FOR RESEARCH, EDUCATION, AND QUALITY (CREQ) HELPS PEDIATRIX
“TAKE GREAT CARE OF THE PATIENT”
Discover Understand Teach
Empowered
providers
Educated
parents
Better care
Implement
6. Better patient care
You are probably not as good as you think you are
ABP Maintenance of Certification Part IV
Need to demonstrate active participation in CQI every
5 years
▪ Part 1 – Licensure
▪ Part 2 – Evidence of Life Long Learning
▪ Part 3 – Exam (every 10 years)
Research outcomes—new observations
8. Pediatrix Continuous Quality Improvement
A Model for Improving Neonatal Intensive Care
Implement
Bedside Care BabySteps Clinical Data Warehouse
QualitySteps
Implement
CQI Projects
Improved Outcomes
9. Pediatrix Continuous Quality Improvement
A Model for Improving Neonatal Intensive Care
The Pediatrix model for
continuous quality
improvement starts at
the bedside
Physicians and
advanced practice
nurses provide bedside
care to thousands of
babies every day
10. Pediatrix Continuous Quality Improvement
A Model for Improving Neonatal Intensive Care
As daily care is provided, clinical data is entered
into the BabySteps clinical documentation
system to generate clinical notes
Key data is immediately available within the
system to guide clinical decision making:
• Growth charts, medication days, duration of
vascular catheters and endotracheal tubes, etc.
Most importantly, these multiple data points are automatically
extracted into the Clinical Data Warehouse, providing detailed
information on outcomes and key processes in that neonatal
intensive care unit
11. Pediatrix Continuous Quality Improvement
A Model for Improving Neonatal Intensive Care
Clinical Data Warehouse (CDW) is the largest
known database for neonatal medicine. More
than 700,000 patients and 13,000,000 patient
days currently exist in the CDW
More than 20% of the babies receiving NICU
care in the US are included in the CDW
Prior to extraction into the CDW, the clinical data undergoes an extensive
de-identification and validation process to establish compliance with
Common Rule and HIPAA regulations and ascertain data reliability
Personal identifiers are removed from the data, but the NICU location is
retained to enable each practice to view it’s own data and compare and
benchmark their results against the Pediatrix Network
12. Pediatrix Continuous Quality Improvement
How does data get from BabySteps to the CDW??
Clinical data
(medications, procedures,
diagnoses, cultures, lab
results, etc) is entered
into BabySteps
Key fields (563 data
points) are extracted and
imported into the CDW
database to generate
specific clinical reports
13.
14.
15.
16. Pediatrix Continuous Quality Improvement
How does the CDW work?
Multiple clinical
reports are available,
including mortality and
many morbidities.
Numerous reports are
available on nutrition,
medication use,
ventilator days, central
catheter use and
much more
Clinical reports can be filtered in various ways,
such as by birth weight, gestational age,
inborn/outborn status, region, and NICU volume
17. Clinical DataWarehouse evolution
Most detailed database for neonatal medicine
More than 700,000 pts. and 13,000,000 pt. days
Forms the basis for many CQI projects at both corporate
and local levels
Queried for information by NIH, FDA, NICHD Neonatal
Network
Recognized by AAP and ABP for its scope
▪ Pediatrix selected as charter member ofAAP/ABP Quality
Improvement Committee
▪ CDW and QualitySteps will serve as basis for Board Maintenance
ofCertification Part IV for Pediatrix MDs (“Portfolio Sponsor”) of
ABP – first (and only) group to date granted this privilege
18. Pediatrix Continuous Quality Improvement
CDW Report Example: Breast Milk in the First Week
Breast Milk in the First Week
Gestation: All; Birth Weight: 501 - 1500g
Admit Group: Inborn; Network: High Volume PDX Sites
Report Name:
Filters:
Pediatrix Network
33rd-66th Percentile
(blue area)
Specific NICU’s
Breast Milk Rate
(green line)
19.
20. Pediatrix Continuous Quality Improvement
QualitySteps: CQI Project Documentation Tool
Data from the CDW is
used to determine what
areas are in need of
improvement
QualitySteps provides
resources and guidance
for the development and
implementation of CQI
projects
QualitySteps serves as a CQI project management tool. Project goals, teams,
progress notes, additional data, and more are collected and stored on the
system, enabling multidisciplinary teams to collaborate efficiently on projects
21. The Run Chart will have all the data points you documented
along with annotations.
22. By programming an
appropriate series of
questions, QualitySteps
has the flexibility to be
used in any specialty of
medicine
Currently developing
anesthesiology module
as seen here
23. Pediatrix Continuous Quality Improvement
Implementing CQI Projects
During project
implementation, data from
BabySteps continuously
feeds into the CDW, with a
one week time lag
This provides the essential
data feedback needed for
ongoing improvement
Implement
24. Pediatrix Continuous Quality Improvement
Improved Outcomes
The information that begins
at the bedside is
transformed into in
improvements that come
back to the bedside
The end result: improved
patient outcomes
25. Activity Reports:Types of discharges (home, transfer, in-hospital, etc.); Admissions
by GA; Admissions by BW; Length of stay; Average daily census;Type of delivery
Morbidity and Mortality Reports: Mortality; Survival, BPD at 28 days of life, BPD at
36 weeks’ gestational age, IVH, Late-onset sepsis, NEC, PDA, PVL, RDS and
surfactant use, ROP, Severe IVH, Severe ROP, Pneumothorax; Catheter-related
blood stream infection (rate/1000d)
Management Reports: Maximal ventilator support, Median ventilator Days,
Temperature from DR to NICU,Types of lines inserted and duration of use, Median
daily weight gain during the first 28 days; Hepatitis B immunization rates; Infants
breast feeding during hospitalization; Per cent of infants breast feeding at
discharge; Breast milk in the first week of life;TPN Use Day 1; DR surfactant use;
Bilirubin reports; Discharge Needs (oxygen, monitoring, NG feeding)
Infection reports: Percent of NICU admissions treated with antibiotics; Median
days of antibiotic therapy with negative cultures; Use of cefotaxime; Percent of
patients treated without cultures; Nosocomial/ line sepsis—infections/ 1000
catheter days
Medication reports: All common medications in the NICU, frequency of use
Summary Dashboard Report and NetworkTrends Reports
PracticeTrend Report
26. o Dashboard report for
assessing the
outcomes of any
NICU during a
defined period of
time.
o Performance
Compared to 33-66%
for PDX Medical
Group (blue bar)
29. Report still in
validation stage,
hospital names
covered until
data can be
verified
Lowest 10 performers
Copyright , MEDNAX PSO 2010
Top 10 performers
30. Denial: These data can’t be right!
Anger: Why are they picking on me? Don’t I have enough
to do already?
Bargaining: My patients must be sicker than everyone
else’s, my NICU is different, I don’t agree with those data
definitions, etc.
Depression: I can’t do anything about it anyway….
Acceptance: OK…what can I do to improve the outcomes
in my NICU?
Courtesy of Dan Ellsbury, MD, Pediatrix Medical Group
31. CQI Quality Summits (3x annually)
Three day CQI experience
▪ Led by Dan Ellsbury, MD, and Robert Ursprung, MD
▪ One session held in conjunction with NEO Conference
(Feb.)
▪ Upcoming Meeting in Dallas (Nov.)
PDX physicians expected to attend one session
every two years
CQI efforts underway in MFM, Pediatric
Cardiology,Anesthesiology
▪ Anesthesiology practices to partner in this process
using QualitySteps program
32. No other group has more than 4 approved projects on ABP web site
33. Comprehensive Oxygen Management
for the Prevention of ROP
Evidence-Based Principles of ROP Toolkit:
•Avoid hyperoxia
•Avoid large oxygen saturation fluctuations
•Educate all NICU staff and parents about ROP
•Provide mechanisms to assess actual implementation
“COMP-ROP”
39. Common use of antibiotics:
Infant with suspected sepsis
(Most common NICU admission)
Hypothesis:
Ampicillin-Gentamicin and
Ampicillin-Cefotaxime are
equivalent approaches…
or are they?
Evaluated > 128,000 infants
Clark et al., Pediatrics 2006; 117:67
40. 23 to 26 27 to 30 31 to 34 35 to 38 39 to 42
Adjusted Odds Ratio 1.14554672 1.61184607 1.78188665 1.87900805 1.43224032
0
0.5
1
1.5
2
2.5
AdjustedOdds Ratio
Clark et al., Pediatrics 2006; 117:67
Wks. gestation
N > 128,000
Odds
Ratio
41. Example: Cefotaxime Use
After dissemination of data showing fungal infection and increased mortality with
cefotaxime use, network use of cefotaxime dropped markedly
Fungal infection
and cefotaxime
Increased mortality
43. Singh BS, Clark RH,
Powers RJ, and Spitzer AR.
J. Perinatol. 2009; 29:497
44. Ibuprofen-Indomethacin Comparison
Inhaled Nitric Oxide in Premies
Neonatal Renal Insufficiency
March 2010 Clinics in Perinatology on
CQI, edited by Ellsbury and Spitzer
46. Clark RH, et al. J. Perinatol., 2010; 30: 800-804
47. Significant numbers of
premature infants have
renal problems in the
neonatal period
Categorization of these
issues is variable from
NICU to NICU, yet it is very
important to establish clear
criteria for renal failure
49. Olsen et al., Pediatrics
2010;125:e214–e224
Significant Differences
from Lubchenko growth
charts, done in Denver
more than 40 years ago
Problems: few survivors
<30 weeks gestation,
altitude at Denver
To be distributed
nationally by Abbott
Nutrition
51. Dan Ellsbury MD
Director, Continuous Quality Improvement
Center for Research and Education
Pediatrix Medical Group
52. Perform an innovative, comprehensive system
redesign of critical practices and procedures in
neonatal intensive care
Over a two year period, redesign the system of
care provided to 100,000 NICU babies within
Pediatrix Medical Group
Build a reusable national infrastructure for
continuous quality improvement in neonatal
intensive care
Extend campaign to include academic centers
53. The problem is not the clinician, it is the complex
system in which the clinician practices (Institute of
Medicine)
The most efficient and productive way to
improve outcomes is by re-engineering care to
produce optimal outcomes
Imploring clinicians to “try harder” is not productive: we must fix the system,
not fight the system
Re-engineering requires accurate, detailed data
BabySteps DataWarehouse and QualitySteps for data
collection
54. Enhance Nutrition:
Maximize breast milk use, use a standardized feeding protocol, and provide
early protein
Improve Medication Use:
Optimize use of antenatal steroids, caffeine, and surfactant. Optimize
antibiotic choice and exposure, decrease cephalosporin use, H-2 blocker
use, and postnatal steroid use, standardize oxygen management
Minimize MechanicalVentilation:
Minimize ventilator duration, Optimize nasal CPAP technique
Optimize Central Line Use:
Standardized central line insertion process, standardized central line
maintenance process, and minimize central line duration
Reduce Suboptimal AdmissionTemperatures:
Standardize initial thermal management
55. Catheter Associated Bloodstream Infection (CABSI)
501-1500 gm, all PDX sites.
2010 is a partial year
CABSI Toolkit
100000 Babies
56. Breast Milk in the First Week
501-1500 gm, all PDX sites.
2010 is a partial year