Introduction:Human papillomavirus (HPV) infections and HPV-related cancers are preventable with vaccination. Initiating the HPV vaccine series at ages 9-10 years is associated with improved vaccination uptake and series completion. This quality improvement (QI) initiative aimed to increase first-dose HPV vaccination rates among 9- to 10-year-olds through the implementation of evidence-based interventions. Methods:Data were collected from electronic health records (EHRs) of established patients aged 9-10 years with at least 1 documented well-child visit annually from 2021 to 2024. Baseline data were obtained from January 2021 through May 2022. Interventions included provider education, adoption of a system-wide "Start at 9" policy, patient-facing educational materials, and EHR modifications to integrate HPV vaccine orders for patients aged 9 years and older. Monthly vaccination trends were evaluated using a P-chart. Results:A total of 9315 patients aged 9-10 years were included. The percentage of eligible patients receiving their first HPV vaccine increased from a baseline of 2% to 14% following the adoption of the "Start at 9" policy in conjunction with targeted educational interventions and EHR integration. A P-chart demonstrating special cause variation aligned with 2 QI interventions, indicating a sustained process shift. Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination rates, used as balancing measures, remained stable throughout the study period. Conclusions:A coordinated, systems-level QI approach was associated with significant gains in early HPV vaccine initiation, supporting initiation of vaccination at age 9 years as an effective strategy to promote timely vaccination and strengthen preventive health outcomes.
Introduction:Extremely preterm infants face a high risk of bronchopulmonary dysplasia from prolonged mechanical ventilation. Early extubation to noninvasive respiratory support may reduce lung injury. Evidence suggests that nasal intermittent positive pressure ventilation (nasal IPPV) lowers reintubation compared with continuous positive airway pressure. Understanding neonatal intensive care unit providers' practice preference, an aspect of unit culture, can facilitate adoption of practice change. This quality improvement initiative aimed to reduce rates of reintubation within 7 and 10 days of first extubation among intubated infants born before 28 weeks' gestational age within 1 year of implementing the practice change and to assess changes in unit culture following guideline implementation. Methods:A guideline recommending extubation to nasal IPPV for infants born before 28 weeks' gestational age and/or 1250 g or less at birth was developed following measurement of staff practice preferences using the Neonatology Survey of Interdisciplinary Groups in Healthcare (NSIGHT) and internal data review, implemented in a level III neonatal intensive care unit in 2023. Data from January 2020-September 2025 were analyzed using statistical process control charts. The validated NSIGHT was repeated in August 2025 and compared with preimplementation results. Results:Over 5.5 years, 200 eligible infants were extubated. Reintubation rates within 7 days changed (from 39% in 2020 to 13% in 2025; P = 0.058). Rare-events analysis demonstrated special cause variation in 2025, with an increasing number of extubations between reintubation events. A significant shift was detected in the extubation rate to nasal IPPV from 32% to 83%. The 2025 NSIGHT results showed a net unit preference for nasal IPPV after extubation (P < 0.001). Conclusions:A practice guideline, informed by NSIGHT results and internal data, was implemented to promote extubation of extremely preterm infants to nasal IPPV. Changes were achieved in clinical practice, reintubation rates, and unit culture.
Introduction:Central line-associated bloodstream infections (CLABSIs), despite the application of best practices, are still prevalent and cause significant morbidity and mortality in pediatric patients. We describe a quality improvement project with an aim to reduce inpatient CLABSIs focused on standardization and proactive risk assessment. Methods:The aim was to reduce inpatient CLABSI rates by 30% within 3 years beginning in January 2021. An apparent cause analysis in 2018 suggested that the lack of escalation of concerns was a potential focus area. We used Plan-Do-Study-Act cycles starting with a pilot in 2019 to roll out a CLABSI Watcher Program. After a CLABSI prevention summit in 2020, a reorganization of drivers reidentified the need for a standardized escalation process for central line (CL) concerns. A CL nurse program was then scaled across the hospital, focusing on timely proactive huddling. Hospital-wide standardization of practices occurred from 2021 to 2023. We used statistical process control charts to assess changes in CLABSI rates. Results:Special cause variation, with a downward shift in the CLABSI rate process mean compared with baseline (0.97 per 1,000 CL days), was observed starting June 2021 (0.13 per 1,000 CL days). A second shift occurred from August 2023 through December 2024 (0.00 per 1,000 CL days). The CLABSI rate decreased by 65% (0.34 per 1,000 CL days) through December 2023. Conclusions:Significant reductions in hospital CLABSI rates can be achieved by using additional measures beyond focusing on CL maintenance and insertion bundles, and particularly through developing proactive risk assessment and escalation processes.
Introduction:Severe traumatic brain injury (TBI) is a major cause of pediatric morbidity and mortality; yet, adherence to national guidelines remains variable. Methods:We conducted a single-center quality improvement initiative in our 48-bed pediatric intensive care unit at a level 1 trauma center. Interventions included adding a TBI order set to the electronic health record and a structured "report card" audit-and-feedback system to monitor compliance with specified metrics in the first 72 hours of admission. The primary outcome measure was the number of severe TBI encounters with 50% or greater adherence to institutional guidelines. Process measures included the use of the order set and timeliness of report card dissemination. Key clinical metrics were also tracked. Analyses involved run charts, descriptive statistics, and nonparametric tests. Results:Of 72 children with severe TBI admitted, 60 were eligible for full guideline adherence assessment. Order set adoption increased from 13% to 92% following the implementation of the report cards and remained above 89% annually thereafter. Guideline adherence increased from 21% to 38.9% postreport cards and stabilized between 42.9% and 59.8% thereafter. Adherence was highest for temperature management, seizure prophylaxis, and cerebral perfusion pressure, whereas sodium and carbon dioxide targets remained challenging. Mortality did not differ by adherence. Higher adherence correlated with longer pediatric intensive care unit, hospital, and rehabilitation stays. Conclusions:Decision support tools and audit and feedback improved adherence to severe pediatric TBI guidelines. Future multicenter studies should assess how adherence affects functional recovery.
Introduction:Acute kidney injury (AKI) is a common complication of nephrotoxic medication use in hospitalized children. Prior studies have shown that the use of electronic health record alerts to identify patients exposed to nephrotoxic medications reduced exposure and the incidence of AKI. This initiative aimed to reduce the incidence of AKI by implementing a process to identify nephrotoxic exposures and standardize care for patients receiving nephrotoxic medications. Methods:We used quality improvement methodology to identify and reduce nephrotoxic medication exposure and to standardize hydration and monitoring for patients receiving them. We tested the process on a single hospital service before expanding to other services, with ongoing optimization via monthly Plan-Do-Study-Act cycles. Results:During the 48-month study period, we observed a significant decrease in the mean number of patients exposed to nephrotoxic medications, from a baseline of 11.3 patients per 1,000 patient-days per month to 6.6 patients per 1,000 patient-days per month, a 42% decrease. For patients exposed to nephrotoxic medications, there was an increase in AKI monitoring (via increased creatinine testing) and an increase in the percentage who developed AKI. Conclusions:We adapted and implemented a screening process for exposure to nephrotoxic medications, along with a novel hydration and monitoring pathway. Consistent with previous studies, we observed a dramatic decrease in exposure. An increase in the detection of AKI and a reduction in the proportion of lower risk patients may explain the unexpected increase in the percentage who developed AKI. Our study suggests that implementing standardized identification and monitoring processes can reduce exposure, and that automation and adherence monitoring are important for demonstrating reductions in AKI.
Introduction:People with bleeding disorders (PwBD) often rely on the emergency department (ED) for clotting factor concentrate (CFC) administration for apparent or suspected bleeding. Timely CFC administration reduces complications but is challenging due to high ED patient volumes and uncertainty about the treatment type, dose, and timing (especially in the pediatric population). Our project aimed to improve the time to CFC for PwBD presenting to the ED with bleeding concerns, with an initial SMART (specific, measurable, achievable, relevant, and time-bound) aim of decreasing the median time from 129 to 99 minutes within 6 months. Methods:Our interventions included educational initiatives, personalized management cards, improved hematology-to-ED communication, and the development of an evidence-based algorithm and guideline. Results:We exceeded our SMART aim, reducing the median time to CFC to82 minutes during the 6 months, and since then we have further improved treatment times, with a median time to CFC of 61 minutes since project initiation (53% reduction from baseline) and a median time to CFC of 41 minutes during the most recent 6 months of data collection (68% reduction from baseline). Conclusions:Our results highlight the successful and sustained application of quality improvement methodologies to improve CFC administration time in PwBD.
Introduction:Multiple studies have noted significant rates of emotional and developmental concerns in children, coupled with inconsistent rates of engagement with related services. Such inconsistency can lead to a range of negative outcomes. Our project aimed to increase the number of children who completed the intake process following referral to the Child Development Center from 57% to 80% by the end of the second quarter of 2022. Methods:The project team identified barriers to referral adherence and developed targeted interventions to address them. Plan-Do-Study-Act cycles included interventions such as moving the intake process to a phone call, direct outreach to families, enhancing education on Child Development Center services, and increasing communication with referring providers. We used control charts to assess the impact of interventions. Results:Completed intakes increased from 57% to 85% within 2 months and remained between 83% and 89% for the rest of the study. Referral completion rates for children younger than 5 rose from 45% to 75% or higher. The referral completion rate did not vary by ethnicity, race, or insurance type. Although increased referral completion rate led to increased wait times for appointments, 83% of patients who completed an initial intake followed through with an appointment at the Center. Conclusions:We used a quality improvement methodology to increase the percentage of patients who completed an initial intake following referral to the Center. The use of a phone intake option and consistent seeking of feedback and collaboration with all stakeholders involved in the project contributed to its success.
Introduction:Maintenance of Certification (MOC) projects have previously been shown to improve diagnostic accuracy and infection treatment in inpatient settings. Methods:We developed and delivered an MOC project in our ambulatory care network in 2023 to increase the use of American Academy of Pediatrics guideline-concordant antibiotic selection and duration for the treatment of acute otitis media (AOM), including amoxicillin for most patients, and the use of shorter (5-7 d) antibiotic durations in children over 2 years with nonsevere symptoms. We evaluated the use of guideline-concordant antibiotics across the network from January 2021 to September 2025, including periods before, during, and after the MOC intervention. We compared the use of guideline-concordant antibiotics between clinics that participated in the MOC intervention and those that did not. Results:The study period included 40,329 AOM episodes. By the end of the study period, 64.7% of children with AOM across the network received guideline-concordant antibiotic selection and duration, up from 46.6% at baseline. After the intervention, MOC-participating clinics had increased use of guideline-concordant antibiotic selection and duration compared to nonparticipating clinics (70.1% versus 54.5%). The frequency of patients returning within 7 days for a repeat AOM visit did not differ between the baseline period (124/12,735; 1.0%) and the postintervention period (303/27,594; 1.1%) (P = 0.3). Conclusions:An MOC program was effective in increasing guideline-concordant antibiotic prescriptions for pediatric AOM across an outpatient network. This effect persisted over time and was stronger in MOC-participating clinics. MOC participation has the potential to improve antibiotic stewardship in ambulatory settings.
Introduction:Early skin-to-skin contact (SSC) during the golden hour after birth offers multiple benefits for newborns and mothers. Despite World Health Organization and United Nations Children's Fund recommendations, baseline SSC rates in our unit were only 7% for vaginal deliveries and 10% for cesarean deliveries. We therefore aimed to increase the early SSC rate to more than 80% from baseline within 10 weeks. Methods:A multidisciplinary team of doctors and nurses conducted this quality improvement initiative in Southern India over 10 months (September 2023-June 2024) using the point-of-care quality improvement model (POCQI_learner_manual_ver 03_2020.pdf). Stable neonates of 34weeks or older included, measured baseline rates during 4 weeks, and tested 4 change ideas during the next 10 weeks. We assessed sustainability for 6 months after the intervention. Results:Out 1312 neonates of gestation age 34 weeks or older, 854 were eligible (513 vaginal deliveries and 341 cesarean deliveries). The mean gestational age was 37 ± 1 weeks (mean ± SD), and the mean birth weight was 2,929 ± 445 g (mean ± SD). Implementation of change ideas-including standardized documentation, simulation-based training, and task-sharing with nursing students and aides-improved SSC rates to 85% for vaginal deliveries and 91% for cesarean deliveries. We sustained these gains, with rates consistently remaining more than 85% during the sustainability period. Conclusions:This quality improvement initiative enhanced healthcare providers' knowledge, competence, and confidence in facilitating SSC, resulting in a marked and sustained change in practice. Future studies should explore scalability across diverse healthcare settings.
Introduction:Prompt administration of bronchodilator therapy via metered-dose inhalers (MDIs) is critical to optimizing clinical outcomes in children with bronchospasm. At our children's emergency department, baseline data indicated that the average interval between the first and second MDI bronchodilator cycles was 44.4 minutes, highlighting delays in bronchodilator therapy. The primary objective was to achieve a 30% reduction in the time interval between the first and second bronchodilator MDI cycles within 1 year. Methods:This multidisciplinary quality improvement project was conducted using the Plan-Do-Study-Act model. Children aged 4-13 years presenting with clinical symptoms requiring bronchodilator therapy via MDI (salbutamol ± ipratropium) were included. Key interventions included revising the workflow to allow nurse-supervised parent administration of MDI, supported by information leaflets, educational videos, nurse-led demonstrations, competency checks, and a designated space for MDI administration. Our primary outcome measure was the time taken to administer the second cycle. Secondary outcome measures focused on parental competency and parent and nurse satisfaction. Results:From August 2022 to June 2023, our educational program reduced the mean time to administer the second MDI cycle from 44.3 (SD 31.3) to 27.6 (SD 8.1) minutes (P < 0.001). Ninety-eight percent of parents were competent on their first attempt. Both parents and nurses reported high satisfaction with the initiative and perceived it as safe. Conclusions:Parent-administered MDI significantly reduced the time interval between the first and second cycles and was highly accepted by parents and nurses, demonstrating an effective, sustainable approach to reducing delays in MDI administration in the emergency department.
Introduction:Preventing ambulatory central line-associated bloodstream infections (A-CLABSIs) is challenging due to inconsistent education, follow-up, and home care practices. Pediatric intestinal failure (IF) patients are particularly vulnerable. This institution aimed to decrease its IF A-CLABSI rate by 25% within 2 years through a standardized, step-by-step central line care education program. Methods:Using the Toyota problem-solving method, the team reviewed data and performed a root cause analysis of the prioritized problem, implementing a 2-phase education program. Phase 1 delivered in-hospital education using videos, handouts, and hands-on teaching with skill demonstration. The existing pediatric central line skills class was expanded and offered to partnering home health agencies. Phase 2 included postdischarge follow-up via phone calls or clinic visits to address questions and identify needs. Family feedback was collected through surveys. Results:The average IF A-CLABSI rate decreased from 3.66 per 1,000 ambulatory line days to 1.85, representing a 49.5% reduction (P = 0.1479). One hundred percent of families surveyed at 7 days postdischarge reported confidence in providing central line care at home and found follow-up phone calls very helpful. Among 44 home health staff trained, the mean percent improvement in pre- to posttest scores was 47%. Families and home health personnel especially valued the hands-on learning component. Conclusions:The standardized education program substantially reduced the rate of IF A-CLABSIs and improved confidence and satisfaction among families and home health nurses. It also enhanced collaboration among families, home health agencies, and the health system, fostering trust and continuity of care.
Introduction: The American Academy of Pediatrics Section on Emergency Medicine’s Choosing Wisely Campaign includes recommendations discouraging comprehensive viral panel testing in children with suspected respiratory viral illness. In the year preceding project implementation, our free-standing pediatric emergency department (PED) ordered comprehensive respiratory pathogen panels (RPPs) in 11.9% of all visits, and 50% of those lacked a clinical indication. This project aimed to reduce the percentage of PED visits with RPP orders from 11.9% to 9% over a 6-month viral respiratory season. Methods: We conducted four major interventions over 2 plan-do-study-act cycles. Interventions included developing a clinical guideline for viral testing, performing provider education, introducing a narrower-spectrum Quad (influenza A/B, COVID-19, and respiratory syncytial virus) polymerase chain reaction (PCR) test, and adding an order-entry indication requirement for RPPs, which also served as a just-in-time educational tool for providers. We tracked data via a clinical dashboard and through periodic chart reviews. Results: Of the 43,283 patient visits during the project period, the percentage of PED RPP orders decreased from 11.9% at baseline to 6.8% during the intervention period and remained at 6.8% in the following respiratory season. The project had sustained cost savings of over $300,000 in RPP testing each year. The decrease in RPP orders did not lead to an increase in the cumulative use of other viral tests. Conclusions: This quality improvement initiative significantly improved and sustained comprehensive viral PCR testing practices in the PED without increasing the use of alternative respiratory viral testing.
Introduction:Asthma, a leading cause of pediatric hospitalization, affects more than 6 million US children and costs more than $5 billion annually. Continuous aerosolized albuterol (CAA) effectively treats severe exacerbations but is typically reserved for intensive care or emergency settings. This quality improvement project aimed to safely expand CAA use on the general care floor (GCF) by monitoring treatment uptake, protocol adherence, and safety outcomes. Methods:This single-center quality improvement project, led by a multidisciplinary team, included children aged 2-18 years with status asthmaticus on CAA who met the inclusion criteria. Interventions involved protocol development, staff education, electronic health record updates, and a resident-led handoff huddle. Primary outcomes were non-pediatric intensive care unit (PICU) CAA hours and the proportion of patients treated on the GCF. Process measures included protocol use and handoff huddles. Balancing metrics included PICU and emergency transfers, fluid-refractory hypotension, and ED length of stay. Results:From June 2024 to October 2025, GCF CAA accounted for 17% of total hospital CAA, surpassing the 10% target. ED length of stay remained unchanged, indicating no disruption to workflow. We safely treated 72 patients on the GCF (average CAA duration of 21.6 h); 22 (31%) required PICU transfer; none were emergent transfer. This intervention saved 1,017 PICU hours (42.4 PICU bed-days), equivalent to $275,600 in room-and-board costs. These savings represent a substantial reduction in PICU resource use; however, we did not conduct a formal cost-effectiveness analysis. Conclusions:CAA can be safely administered in the GCF following a structured protocol, reducing the need for PICU resources without adversely affecting ED care efficiency.
Introduction:Pediatric heart centers have advanced quality improvement (QI) work through registries and collaboratives, improving benchmarking and shared learning. However, institutions must also build internal, sustainable QI programs tailored to local needs. We outlined our experience in developing an inclusive QI program that provides a structured framework to drive continuous improvement.Methods:We implemented a 5-step approach: (1) cultivating an environment ready for change, (2) optimizing streams to identify improvement opportunities, (3) building systems to support initiatives, (4) promoting QI work and successes, and (5) sustaining and scaling improvements. This included engaging diverse stakeholders, streamlining data, reducing participation barriers, and applying structured project management. Proposals underwent rigorous review to ensure equitable support.Results:Between 2021 and 2025, the program supported 17 subgroups across cardiology, surgery, anesthesia, and critical care, with 60% of projects led by nonphysicians. It facilitated 21 QI consults (71% progressing to formal projects), 13 publications, more than 30 national presentations, and additional impactful unpublished work, while strengthening leadership and team expertise through QI education. System-level outcomes improved, including surgical mortality and US News & World Report rankings. Performance rounds generated 170 improvement actions to guide systematic change.Conclusions:An inclusive QI program enhances outcomes, and our structure underscores the value of both multidisciplinary collaboration and strategic resource use. By investing in leadership, promoting diversity, and aligning with institutional goals, heart centers can achieve sustained improvement. This framework offers a potential model for institutions seeking robust QI infrastructure.
Introduction:The threshold for ordering blood cultures and initiating empiric broad-spectrum antibiotic therapy is often low in pediatric cardiac intensive care units (CICUs). However, excessive blood cultures carry risks, including anemia, false-positive results, and contamination related to vascular access. Overuse of broad-spectrum antibiotics can lead to the development of multidrug-resistant bacteria.Methods:In this quality improvement initiative focused on diagnostic stewardship, a blood culture algorithm was developed to reduce unnecessary blood culture sampling in patients with low sepsis probability. All patients admitted to the CICU were included in the study. The preimplementation observation period spanned from January 2022 to June 2023, and the postimplementation observation period lasted from July 2023 to December 2025.Results:There were 5,958 CICU admissions during the study period, with no statistically significant difference in the baseline clinical characteristics. The number of blood culture samples declined by 26% in the postimplementation period, from 111.9 to 82.8 per 1,000 patient-days (P < 0.001), and a centerline shift was observed after the 5-month mark in the statistical process control U-chart. No statistically significant change was observed in the central line-associated bloodstream infection rate per 1,000 line-days (1.7 versus 1.3, P = 0.26).Conclusions:A structured algorithm to support clinicians' decision-making for blood culture testing resulted in a statistically significant reduction in the number of blood cultures sent. The delayed centerline shift indicated that lasting change required complete practice adoption rather than mere intervention launch. This intervention was not associated with any safety concerns in clinical outcomes.
Introduction:Multidisciplinary clinical debriefs are structured discussions following critical events to assess performance, identify improvement opportunities, and provide team support. Despite known benefits, debriefs are underused. We aimed to increase debrief completion following pediatric emergency department (ED) cardiac arrests and endotracheal intubations. The primary outcome was the percentage of critical events with a completed debrief form. To assess potential workflow disruptions, we assessed 2 balancing measures: room-to-provider and door-to-provider times among Emergency Severity Index level 1 and 2 patients.Methods:A key driver diagram guided targeted interventions. We implemented a standardized Research Electronic Data Capture (REDCap) debrief form using a plus-delta framework with scripted prompts, accessible via quick response codes throughout the ED. As part of the intervention design, debriefs were encouraged within 30 minutes of the event and were designed to last 7 minutes or less. Educational initiatives included staff meetings, email reminders, newsletters, signage, and designated nursing champions. We used statistical process control to assess changes over time.Results:Debrief completion increased from 4% to 52% during 15 months, showing special-cause variation. Median room-to-provider times remained unchanged. Median door-to-provider times decreased during the intervention period.Conclusions:Multiple interventions significantly increased the use of structured debriefing without adversely affecting patient flow. Structured debriefing is both feasible and sustainable in high-acuity ED settings, particularly when supported by ongoing education and active team engagement.
Introduction:Preterm newborns in neonatal intensive care units face high antibiotic exposure despite low culture positivity. To address this, the National Maternal and Perinatal Institute, Peru, and the Andean Health Organization launched a project to reduce neonatal antibiotic use by 20% from May 2023 to May 2024. Method:A quality improvement project was designed at the National Maternal and Perinatal Institute in collaboration with the Andean Health Organization as part of a multinational initiative. The project used key driver identification and Plan-Do-Study-Act cycles to enhance antibiotic stewardship in early-onset sepsis (EOS) and late-onset sepsis (LOS) cases. Monitoring focused on identifying cases of treatment failure, recurrence, and mortality rate. We present results on Laney p'-charts stratified by EOS and LOS for the antibiotic use rate. Newborn characteristics are presented in comparative tables by sepsis type. Results:We included 647 newborns for suspected sepsis, comprising 982 episodes. Antibiotic use decreased by 17.3% for EOS and 25.9% for LOS. In EOS, rule-out sepsis was predominant (67.2%), whereas confirmed sepsis was predominant in LOS (40.6%). EOS was more common in term infants with a birth weight of 1,500 to 2,500 g, whereas LOS was predominant in preterms younger than 32 weeks with a birth weight of 1,000 to 1,500 g. No treatment failures or early recurrent sepsis were observed after discontinuation of antibiotics. No readmissions occurred within 30 days. EOS mortality was 15.8% and LOS mortality was 20.2%, with a decline in overall mortality from 3.5 to 3.0 per 1,000 live births across semesters. Conclusions:The quality improvement project improved neonatal sepsis management, reduced antibiotic use, and optimized treatment protocols.
Introduction:Accurate measurement is important in quality improvement. International Classification of Diseases (ICD) codes are often used to measure hospital-acquired venous thromboembolism (HA-VTE) rates, but they have high detection error rates. Our objective was to compare HA-VTE rates of various automated calculation methods and their accuracy. Methods:Single-center retrospective study including children younger than 18 years admitted between 2018 and 2023. We developed 4 automated methods to identify potential HA-VTE cases using (1) ICD-10 codes, (2) vascular extremity ultrasound reports (USG), (3) hematology consult reasons (Heme), and (4) receipt of therapeutic-dosing enoxaparin (Meds). We reviewed charts to determine true HA-VTE, defined as the radiographic presence of a thrombus. Additionally, we reviewed all charts with a vascular extremity ultrasound performed during the study period for true HA-VTE. We computed the accuracy of each method. Results:Across 33,430 admissions, we detected 275 (0.82%) cases by ICD, 508 (1.5%) by USG, 151 (0.45%) by Heme, and 176 (0.53%) by Meds. We manually reviewed 869 charts, of which 180 (0.5%) had confirmed HA-VTE. The false-positive rate was highest for USG (70.7%), followed by ICD (52.4%), Heme (50.9%), and Meds (43.8%). The combined false-positive rate was 59.2%. Sensitivity was highest for USG (82.8%), followed by ICD (72.8%), Heme (41.1%), and Meds (55.0%). Specificity was highest for Meds and Heme (88.8%). Discriminative performance was best for Meds (with an area under the precision-recall curve: 44.3%). Conclusions:Combining multiple methods led to greater identification of HA-VTE without significantly increasing false-positive rates, making it useful for quality improvement surveillance. Detection based on Meds is a more accurate alternative to ICD codes.
Introduction:Breastfeeding during the golden hour after birth is crucial for establishing successful long-term breastfeeding. Despite the World Health Organization recommendation, according to the National Family Health Survey-5, the first-hour breastfeeding rate in India following cesarean delivery is only 23.9%. We aimed to improve the first-hour breastfeeding rate in stable neonates born through cesarean delivery from the baseline of 9% to 80% within a period of 4 weeks. Methods:This quality improvement initiative was conducted in Southern India during 8 months (April 2022 to November 2022) by a multidisciplinary team comprising doctors and nurses. The baseline first-hour breastfeeding rate among inborn, stable neonates of 34 weeks' gestation or greater delivered via cesarean section was assessed during a 10-week period. The Point Of Care Quality Improvement model (POCQI_learner_manual_ver 03_2020.pdf) was used to enhance the breastfeeding rate during 4 weeks. Successful change ideas were adopted, and their sustainability was evaluated during the 22-week sustenance period. Results:Out of the 592 neonates delivered by cesarean section at a gestational age of 34 weeks or older, 418 were eligible. The average gestational age and birth weight were 38 weeks (±1.4) and 2916 g (±489), respectively. The first-hour breastfeeding rate increased from a baseline of 9.6% to 100% at the conclusion of the intervention phase, and this was maintained at greater than 90% throughout the sustainability period. Conclusions:This quality improvement initiative enhances healthcare workers' knowledge, competence, and confidence in immediate first-hour breastfeeding within the operating theater. Further research is required to assess the potential for generalization across diverse units.
