Quality Improvement Initiative Enhances Outpatient Pediatric Pulmonology Follow-up for Premature Infants with Bronchopulmonary Dysplasia

Abstract

Introduction: Bronchopulmonary dysplasia (BPD) is a chronic lung disorder affecting many premature infants. Infants with BPD have higher hospital readmission rates due to respiratory-related morbidity. We aimed to increase the rates of outpatient pulmonary follow-up and attendance of premature babies with moderate and severe BPD to above 85% within 6 months.

Methods: We conducted a quality improvement project at Yale New Haven Children's Hospital. Key interventions included developing a BPD clinical pathway integrated into the electronic medical record to assist providers in correctly classifying BPD severity, assigning the appropriate International Classification of Diseases, 10th Revision code (P27.1), and providing standardized treatment options. The outcome measures included correct diagnosis and classification of BPD, the percentage of patients with BPD scheduled for pediatric pulmonology appointments within 45 days, and the percentage attending those appointments.

Results: There were 226 patients in our study, including 85 in the baseline period. Correct diagnosis of BPD increased from 49% to 95%, the percentage of scheduled appointments increased from 71.9% to 100%, and the percentage of appointments attended increased from 55.6% to 87.1%.

Conclusions: Our quality improvement initiative improved the accuracy of diagnosis, severity classification, and outpatient pulmonary follow-up of children with moderate and severe BPD.

Fig. 1.

BPD definition and severity as recommended by Jensen et al. CPAP, continuous positive airway pressure; NIPPV, nasal intermittent positive pressure ventilation.

Fig. 2.

Pareto chart for the 41 BPD patients during the baseline period from January 21 to December 21.

Fig. 3.

Key driver diagram.

Fig. 4.

BPD pathway. ASD; BMP; CXR; GRAD; NNICU; PDA; PEEP; RA; YNHCH, Yale New Haven Children’s Hospital. ASD, atrial septal defect; BMP, basic metabolic panel; CXR, chest x-ray; GRAD, graduate; NNICU, neonatal intensive care unit; PDA, patent ductus arteriosus; PEEP, positive end-expiratory pressure; RA, room air.

Fig. 5.

Statistical process control chart for appointment scheduling. A, Percent appointments scheduled within 45 days of discharge for moderate/severe BPD. Statistical process control chart, January 2021 to January 2024. *Two patients who did not receive a follow-up appointment as their ICD-10 code was mistakenly altered and the time the BPD pathway was revised. B, The number of scheduled patients between unscheduled patients or patient appointments more than 45 days after discharge. Statistical process G chart, January 2021 to January 2024.

Fig. 6.

Statistical process control chart for appointment attendance. A, Percent attendance of scheduled appointments within 45 days for moderate/severe BPD. Statistical process control chart, January 2021 to January 2024. B, The number of scheduled patients attending clinic between those not attending a follow-up appointment from discharge date for moderate/severe BPD. Statistical process G chart, January 2021 to January 2024.