A quality improvement initiative to reduce necrotizing enterocolitis across hospital systems

• DOI: 10.1038/s41372-018-0104-0
• Publication Date: 2018-04-20T10:37:44Z
• Authors: Amy T. Nathan; Laura Ward; Kurt Schibler; Laurel Moyer; Andrew South; Heather C. Kaplan
• Keywords: Male; Databases, Factual; Incidence; Infant, Newborn; Quality Improvement; Risk Assessment; United States; 3. Good health; Primary Prevention; Survival Rate; 03 medical and health sciences; 0302 clinical medicine; Enterocolitis, Necrotizing; Intensive Care Units, Neonatal; Intensive Care, Neonatal; Humans; Infant, Very Low Birth Weight; Female; Hospital Mortality; Retrospective Studies

Necrotizing enterocolitis (NEC) is a devastating intestinal disease in premature infants. Local rates of NEC were unacceptably high. We hypothesized that utilizing quality improvement methodology to standardize care and apply evidence-based practices would reduce our rate of NEC.A multidisciplinary team used the model for improvement to prioritize interventions. Three neonatal intensive care units (NICUs) developed a standardized feeding protocol for very low birth weight (VLBW) infants, and employed strategies to increase the use of human milk, maximize intestinal perfusion, and promote a healthy microbiome.The primary outcome measure, NEC in VLBW infants, decreased from 0.17 cases/100 VLBW patient days to 0.029, an 83% reduction, while the compliance with a standardized feeding protocol improved.Through reliable implementation of evidence-based practices, this project reduced the regional rate of NEC by 83%. A key outcome and primary driver of success was standardization across multiple NICUs, resulting in consistent application of best practices and reduction in variation.