Published online August 31, 2007
PEDIATRICS Vol. 120 No. 3 September 2007, pp. 481-488 (doi:10.1542/peds.2007-0233)
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ARTICLE

Improving Newborn Preventive Services at the Birth Hospitalization: A Collaborative, Hospital-Based Quality-Improvement Project

Charles E. Mercier, MDa, Sara E. Barry, MPHa, Kimberley Paul, BSNa, Thomas V. Delaney, PhDa, Jeffrey D. Horbar, MDa,b, Richard C. Wasserman, MD, MPHa, Patricia Berry, MPHc and Judith S. Shaw, RN, MPHa

a Department of Pediatrics, University of Vermont, Burlington, Vermont
b Vermont Oxford Network, Burlington, Vermont
c Vermont Department of Health, Burlington, Vermont

OBJECTIVE. The goal was to test the effectiveness of a statewide, collaborative, hospital-based quality-improvement project targeting preventive services delivered to healthy newborns during the birth hospitalization.

METHODS. All Vermont hospitals with obstetric services participated. The quality-improvement collaborative (intervention) was based on the Breakthrough Series Collaborative model. Targeted preventive services included hepatitis B immunization; assessment of breastfeeding; assessment of risk of hyperbilirubinemia; performance of metabolic and hearing screens; assessment of and counseling on tobacco smoke exposure, infant sleep position, car safety seat fit, and exposure to domestic violence; and planning for outpatient follow-up care. The effect of the intervention was assessed at the end of an 18-month period. Preintervention and postintervention chart audits were conducted by using a random sample of 30 newborn medical charts per audit for each participating hospital.

RESULTS. Documented rates of assessment improved for breastfeeding adequacy (49% vs 81%), risk for hyperbilirubinemia (14% vs 23%), infant sleep position (13% vs 56%), and car safety seat fit (42% vs 71%). Documented rates of counseling improved for tobacco smoke exposure (23% vs 53%) and car safety seat fit (38% vs 75%). Performance of hearing screens also improved (74% vs 97%). No significant changes were noted in performance of hepatitis B immunization (45% vs 30%) or metabolic screens (98% vs 98%), assessment of tobacco smoke exposure (53% vs 67%), counseling on sleep position (46% vs 68%), assessment of exposure to domestic violence (27% vs 36%), or planning for outpatient follow-up care (80% vs 71%). All hospitals demonstrated preintervention versus postintervention improvement of ≥20% in ≥1 newborn preventive service.

CONCLUSIONS. A statewide, hospital-based quality-improvement project targeting hospital staff members and community physicians was effective in improving documented newborn preventive services during the birth hospitalization.

Key Words: preventive services • quality improvement • infant • newborn • birthing centers • hospital

Abbreviations: BTS—Breakthrough Series • OR—odds ratio • CI—confidence interval • QI—quality improvement

Accepted Apr 23, 2007.