In September 2011, the FPQC hosted representatives from nineteen Florida hospitals with Level II and Level III NICUs participating in the Vermont Oxford Network. The goal of the meeting was to review a combined Florida report of neonatal outcomes data (blinded to patient and individual facility identity) to select the most pressing issues for neonatal quality improvements. One of the priority issues identified by comparison to both Florida and National benchmarks was reducing neonatal infections.
The FPQC team made meeting participants aware of an opportunity to partner with the Perinatal Quality Collaborative of North Carolina (PQCNC) on a project to reduce neonatal catheter associated blood stream infections (NCABSI), funded by the Agency for Healthcare Research and Quality through American Hospital Association (AHA). This initiative involved seven other state quality collaboratives in New Jersey, Massachusetts, North Carolina, Colorado, South Carolina, Wisconsin and Hawaii. At that time, sixteen Florida Level III NICUs signed on to implement the existing protocol utilized across the eight-state project.
As part of the FPQC’s first neonatal-focused initiative, these hospital NICU teams joined with the Florida Hospital Association to create their own listserv for communication of specific expertise and experiences in the implementation of best practices. Additionally, the teams began using rapid cycle changes to prioritize, implement and measure local practices in order to achieve improved outcomes. In order to sustain cultural changes, the teams also began adapting portions of “Comprehensive Unit-based Safety Program” (CUSP) developed at Johns Hopkins University and utilized by the AHA in their adult CABSI and CAUTI projects.
Florida’s sixteen NICUs began entering data in December 2011. Currently, the Florida NICUs provide a quarter of the data for the eight-state project and are having a substantial impact on the national progress of the project. Initial results indicate that Florida has outperformed the national average in an increase in central line insertion compliance within the NICU, a reduction of lines in place for babies receiving enteral feeds of more than 120 ml/kg/day and a decrease in the rate of infection in Florida. Detailed results between December 2011 and August 2012 indicated that 92 infections were avoided in Florida - saving 9 lives, reducing length of stay by more than 640 days and saving over $2.7 million.
Funding will continue the NCABSI project for an additional year. The FPQC plans to add new Florida NICUs and survey currently active team leads to better understand the successes and challenges of their participation in the project. For more information or to get involved, please contact the NCABSI project state leader, Dr. Douglas E. Hardy, at firstname.lastname@example.org .