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Qual Saf Health Care 2005;14:202-206
© 2005 BMJ Publishing Group Ltd.

QUALITY IMPROVEMENT REPORT

Improvement in neonatal intensive care in Northern Ireland through sharing of audit data

J Jenkins1, F Alderdice2, E McCall1 on behalf of the Neonatal Intensive Care Outcomes Research and Evaluation (NICORE) Group

1 Department of Child Health, Queen’s University Belfast, Institute of Clinical Science, Belfast BT12 6BJ, UK
2 School of Nursing & Midwifery, Queen’s University Belfast, Medical Biology Centre, Belfast BT9 7BL, UK

Correspondence to:
Dr J Jenkins
Senior Lecturer in Child Health and Consultant Paediatrician, Paediatric Department, Antrim Hospital, Antrim BT41 2RL; j.jenkins{at}qub.ac.uk
ABSTRACT
Problem: Ten percent of infants born will require admission to a neonatal facility. Coordinated activity to monitor and improve the quality of care for this high risk, high cost group of infants is considered a high priority. At the time of initiation of this project no system for collection and analysis of neonatal data existed in Northern Ireland.

Design: In 1994 an ongoing prospective centralised data collection system was implemented to facilitate quality improvement and research in neonatal care. We aim to ascertain if there has been a demonstrable improvement in the quality of care provided since the initiation of this system.

Setting: All nine Northern Ireland neonatal intensive care units returned prospectively collected socioeconomic, obstetric and neonatal episode data.

Key measures for improvement: Achievement of the agreed quality indicators relating to transfer patterns, thermoregulation, antenatal steroid administration, and timing of administration of surfactant during the period 1 April 1999 to 31 March 2000 were compared with data for the period 1 April 1994 to 31 March 1996.

Strategies for change: Monitoring included audit and annual feedback of timely clear and relevant data where results were provided confidentially as standardised reports, together with anonymised comparisons with other similar sized units. Draft recommendations were made at regional level and units were asked to adopt finalised consensus guidelines at the local level and to implement changes to clinical practice.

Effects of change: The proportion of transfers taking place in utero increased from 26% to 42% and antenatal steroid administration from 68% to 82%. Normothermia on first admission improved from 66% to 71% for inborn infants. The proportion of infants receiving surfactant where the first dose was given within an hour of birth increased from 13% to 66%.

Lessons learnt: A multiprofessional regional care network can facilitate the development of agreed standards and a culture of regular evaluation leading to quality improvement.

Keywords: quality improvement; neonatal intensive care


Relevant Article

Quality Line
Qual. Saf. Health Care 2005 14: 153. [Extract] [Full Text] [PDF]





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