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. 2015 Jan-Feb;20(1):e1-9.

The Evidence-based Practice for Improving Quality method has greater impact on improvement of outcomes than dissemination of practice change guidelines and quality improvement training in neonatal intensive care units

Shoo K Lee  1 , Khalid Aziz  2 , Nalini Singhal  3 , Catherine M Cronin  4
Affiliations

The Evidence-based Practice for Improving Quality method has greater impact on improvement of outcomes than dissemination of practice change guidelines and quality improvement training in neonatal intensive care units

Shoo K Lee et al. Paediatr Child Health. 2015 Jan-Feb.

Abstract
in English, French

Objectives: To determine whether outcome improvements achieved by neonatal intensive care units (NICUs) in the Evidence-based Practice for Improving Quality (EPIQ) trial could be reproduced in other NICUs by providing quality improvement (QI) training and practice change guidelines developed during the EPIQ trial; and to examine whether the results of the EPIQ trial were sustained.

Methods: The present prospective before-after study included 5812 infants born at ≤32 weeks' gestation and admitted to 19 level 3 NICUs in the Canadian Neonatal Network between October 1, 2005 and December 31, 2007. During a three-month baseline period, multi-disciplinary teams received general training in QI techniques at a two-day workshop, and practice change guidelines targeting nosocomial infection (NI) and bronchopulmonary dysplasia (BPD) developed during the EPIQ trial were provided to all participants. Outcome data collected during the intervention period were compared with data from the baseline period and reported quarterly.

Results: In NICUs that had not previously participated in the EPIQ trial (non-EPIQ NICUs), there were no significant changes in the incidence trends of NI or BPD. However, within NICUs that had previously participated in the EPIQ trial (EPIQ NICUs) there was a continued reduction in the incidence trend of NI and BPD among EPIQ NICUs randomized during the trial to reduce NI and BPD, respectively.

Conclusions: Providing NICUs with QI training and practice change guidelines developed during a successful QI initiative in other units is not effective. The authors speculate that successful practice change involves organizational culture and behaviour change, and should be driven by context-specific evidence.

Objectifs: Déterminer s’il est possible de reproduire, dans d’autres unités de soins intensifs néonatals (USIN), l’amélioration des résultats obtenue dans certaines USIN lors de l’essai EPIQ (acronyme anglais de pratiques fondées sur des données probantes pour l’amélioration de la qualité) grâce à une formation sur l’amélioration de la qualité (AQ) et à des directives sur les changements de pratiques élaborées pendant l’essai EPIQ. Examiner si les résultats de l’essai EPIQ se maintiennent.

Méthodologie: La présente étude prospective avant-après portait sur 5 812 nourrissons nés à 32 semaines d’âge gestationnel ou moins et hospitalisés dans 19 USIN de niveau 3 du Réseau néonatal canadien entre le 1er octobre 2005 et le 31 décembre 2007. Pendant une période de référence de trois mois, des équipes multidisciplinaires ont reçu une formation générale sur les techniques d’AQ lors d’un atelier de deux jours. De plus, tous les participants ont reçu des directives sur les changements de pratiques ciblant les infections nosocomiales (IN) et la dysplasie bronchopulmonaire (DBP) élaborées pendant l’essai EPIQ. Les chercheurs ont comparé les données sur les résultats, colligées pendant la période d’intervention, aux données de la période de référence regroupées par trimestre.

Résultats: Dans les USIN qui n’avaient pas participé à l’essai EPIQ auparavant (les USIN non EPIQ), on n’a pas remarqué de changement important aux tendances d’IN ou de DBP. Cependant, au sein des USIN qui avaient participé à l’essai EPIQ (les USIN EPIQ) et qui avaient été choisies au hasard pour réduire les IN et la DBP, respectivement, on constatait une réduction continue des tendances d’IN et de DBP.

Conclusions: Il n’est pas efficace de fournir aux USIN une formation sur l’AQ et des directives sur les changements de pratiques élaborées dans le cadre d’une initiative réussie d’AQ menée dans d’autres USIN. Les auteurs postulent que pour être efficaces, les changements de pratiques doivent susciter des modifications à la culture organisationnelle et aux comportements et reposer sur des données probantes contextuelles.

Keywords: Bronchopulmonary dysplasia; Clinical practice guidelines; Infants; Neonatal intensive care units; Nosocomial infection; Premature; Quality improvement.

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Figures

Figure 1)
Figure 1)
Key driver diagram for reduction of nosocomial infection in the neonatal intensive care unit (NICU). CDC Centers for Disease Control and Prevention (Georgia, USA); IV Intravenous; PICC Peripherally inserted central catheter
Figure 2)
Figure 2)
Key driver diagram for reduction of bronchopulmonary dysplasia in the NICU. BW Birth weight; CPAP Continuous positive airway pressure; NICU Neonatal intensive care unit; NIDCAP Newborn Individualized Developmental Care and Assessment Program; pCO2 Partial pressure of CO2; wk Weeks
See this image and copyright information in PMC

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