Journal article
Reducing Osteopenia of Prematurity-related Fractures in a Level IV NICU: A Quality Improvement Initiative
Pediatric quality & safety, v 9(2), pe723
03 Apr 2024
PMID: 38576890
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Osteopenia of prematurity (OOP) is often a silent disease in the neonatal intensive care unit (NICU). Despite its association with increased neonatal morbidity, such as fractures, wide variation exists in screening, diagnostic, and management practices. We sought to decrease the rate of OOP-related fractures in our level IV NICU by 20% within 1 year.
A multidisciplinary quality improvement team identified inconsistent screening, diagnosis, and management of OOP, as well as handling of at-risk patients, as primary drivers for OOP-related fractures. Using the model for improvement, we implemented sequential interventions, including screening, diagnosis, and a management algorithm as a "handle-with-care" bundle in infants at risk for fractures.
194 at-risk infants were included, 59 of whom had OOP. There was special cause variation in OOP-related fractures, with a reduction from 0.43 per 1000 patient days to 0.06 per 1000 patient days with our interventions. There was also an improvement in days between fractures from 62 to 337 days. We achieved these improvements despite a similar prevalence of OOP throughout the initiative. We showed special cause variation with increased patients between missed OOP documentation and improved collection of OOP screening laboratories at 4 weeks of life without increased blood testing.
A multidisciplinary team approach with standardized OOP screening, diagnosis, and management guidelines, including a handle-with-care bundle, reduces OOP-related fractures in a level IV NICU.
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Details
- Title
- Reducing Osteopenia of Prematurity-related Fractures in a Level IV NICU: A Quality Improvement Initiative
- Creators
- Linsey Cromwell - St. Christopher's Hospital for ChildrenKatherine Breznak - St. Christopher's Hospital for ChildrenMegan Young - St. Christopher's Hospital for ChildrenAnoosha Kasangottu - Drexel UniversitySharon Leonardo - St. Christopher's Hospital for ChildrenCatherine Markel - St. Christopher's Hospital for ChildrenAndreea Marinescu - St. Christopher's Hospital for ChildrenFolasade Kehinde - Drexel UniversityVilmaris Quinones Cardona - Drexel University
- Publication Details
- Pediatric quality & safety, v 9(2), pe723
- Publisher
- Lippincott
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Pediatrics
- Web of Science ID
- WOS:001196005600001
- Scopus ID
- 2-s2.0-85190146415
- Other Identifier
- 991021866434004721
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- Web of Science research areas
- Pediatrics