Revisions of clinical protocols using the Plan Do Check Act cycle improved outcomes of extremely preterm infants at 2 years
Aim Clinical quality improvement is often cumbersome due to established protocols. We aimed to investigate whether outcomes of preterm infants improve with protocol revisions using iteration cycles. Methods Preterm infants born
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| Veröffentlicht in: | Acta Paediatrica 2021-07, Vol.110 (7), p.2100-2109 |
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| container_title | Acta Paediatrica |
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| creator | Saikusa, Mamoru Kinoshita, Masahiro Tsuda, Kennosuke Hisano, Tadashi Okada, Junichiro Iwata, Sachiko Fujino, Hiroshi Maeno, Yasuki Yamashita, Yushiro Iwata, Osuke |
| description | Aim
Clinical quality improvement is often cumbersome due to established protocols. We aimed to investigate whether outcomes of preterm infants improve with protocol revisions using iteration cycles.
Methods
Preterm infants born |
| doi_str_mv | 10.1111/apa.15840 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8360062</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2501266565</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5420-af205a71a7f82b12a4b705e9d34c8cd53e7563146e1a2c5f19c3f80df7fb80793</originalsourceid><addsrcrecordid>eNp1kc1qVDEYhoModlpdeAMScNMuTpufk_OzEYax_kDBIroOmZwvndScZExyxh7wYrwWr8zYqUUFs8kiTx7e73sRekbJKS3nTG3VKRVdTR6gBW0ErRhj7UO0IB3hlWCCH6DDlK4JYbyvm8fogPO2_Gv5An37ADubbPAJB4O1s95q5fA2hhx0cAlPyfornDeAL53y-FXAqw3oz3ipM9azdoDtWOgdDDhMWYcRbk1wkyOM4OaiggxxxNYb5XPCKmP24_sMKqYn6JFRLsHTu_sIfXp9_nH1trp4_-bdanlRaVEzUinDiFAtVa3p2JoyVa9bIqAfeK07PQgOrWg4rRugimlhaK-56chgWrPuSNvzI_Ry791O6xEGDT5H5eQ22lHFWQZl5d8v3m7kVdjJjjeENKwIju8EMXyZIGU52qTBlY1AmJJkglDWNKIRBX3xD3odpujLeIWqedfXhJFCnewpHUNKEcx9GErkr05l6VTedlrY53-mvyd_l1iAsz3w1TqY_2-Sy8vlXvkTcyGtXQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2543894020</pqid></control><display><type>article</type><title>Revisions of clinical protocols using the Plan Do Check Act cycle improved outcomes of extremely preterm infants at 2 years</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Alma/SFX Local Collection</source><creator>Saikusa, Mamoru ; Kinoshita, Masahiro ; Tsuda, Kennosuke ; Hisano, Tadashi ; Okada, Junichiro ; Iwata, Sachiko ; Fujino, Hiroshi ; Maeno, Yasuki ; Yamashita, Yushiro ; Iwata, Osuke</creator><creatorcontrib>Saikusa, Mamoru ; Kinoshita, Masahiro ; Tsuda, Kennosuke ; Hisano, Tadashi ; Okada, Junichiro ; Iwata, Sachiko ; Fujino, Hiroshi ; Maeno, Yasuki ; Yamashita, Yushiro ; Iwata, Osuke</creatorcontrib><description>Aim
Clinical quality improvement is often cumbersome due to established protocols. We aimed to investigate whether outcomes of preterm infants improve with protocol revisions using iteration cycles.
Methods
Preterm infants born <28 weeks gestation between January 2006 and December 2015 were retrospectively analysed. Protocols were revised using Plan Do Check Act cycle. Death and serious adverse events at term were reviewed in six‐monthly quality improvement meetings. Adverse outcome of death or motor/sensory impairments at two years was compared before and after two major protocol changes, which were implemented in January 2008 and January 2012.
Results
Based on the appraisal for period 2006–2007, strategies for surfactant, narcotics, parenteral nutrition, respiratory gas humidity and prophylactic indomethacin and antibiotics were changed for period 2008–2011. For period 2012–2015, stabilisation of infants was accelerated via very early catheterisation. Of 162 infants (84 males, 25.5 ± 1.5 weeks gestation) within the whole cohort, 63 developed adverse outcomes, which were fewer for periods 2008–2011 (p = 0.013) and 2012–2015 (p = 0.035) compared with period 2006–2007 (adjusted for gestational age, Apgar scores and sex).
Conclusion
Careful bottom‐up revisions of protocols using iteration cycles, accounting for local settings, successfully improved the outcomes of preterm infants.</description><identifier>ISSN: 0803-5253</identifier><identifier>EISSN: 1651-2227</identifier><identifier>DOI: 10.1111/apa.15840</identifier><identifier>PMID: 33711173</identifier><language>eng</language><publisher>Norway: Wiley Subscription Services, Inc</publisher><subject>Adverse events ; Antibiotics ; Apgar score ; Clinical Protocols ; extremely preterm infant ; Gestational Age ; Humans ; Indomethacin ; Infant ; Infant, Extremely Premature ; Infant, Newborn ; Infants ; intact survival ; Male ; Narcotics ; neonatal intensive care ; Neonates ; Newborn babies ; outcome and Plan Do Check Act cycle ; Parenteral nutrition ; Premature babies ; Pulmonary Surfactants ; Quality control ; Regular ; Regular & Brief Reports ; Retrospective Studies ; Revisions</subject><ispartof>Acta Paediatrica, 2021-07, Vol.110 (7), p.2100-2109</ispartof><rights>2021 The Authors. published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.</rights><rights>2021 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.</rights><rights>2021. This article is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c5420-af205a71a7f82b12a4b705e9d34c8cd53e7563146e1a2c5f19c3f80df7fb80793</cites><orcidid>0000-0001-9277-1109</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fapa.15840$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fapa.15840$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33711173$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Saikusa, Mamoru</creatorcontrib><creatorcontrib>Kinoshita, Masahiro</creatorcontrib><creatorcontrib>Tsuda, Kennosuke</creatorcontrib><creatorcontrib>Hisano, Tadashi</creatorcontrib><creatorcontrib>Okada, Junichiro</creatorcontrib><creatorcontrib>Iwata, Sachiko</creatorcontrib><creatorcontrib>Fujino, Hiroshi</creatorcontrib><creatorcontrib>Maeno, Yasuki</creatorcontrib><creatorcontrib>Yamashita, Yushiro</creatorcontrib><creatorcontrib>Iwata, Osuke</creatorcontrib><title>Revisions of clinical protocols using the Plan Do Check Act cycle improved outcomes of extremely preterm infants at 2 years</title><title>Acta Paediatrica</title><addtitle>Acta Paediatr</addtitle><description>Aim
Clinical quality improvement is often cumbersome due to established protocols. We aimed to investigate whether outcomes of preterm infants improve with protocol revisions using iteration cycles.
Methods
Preterm infants born <28 weeks gestation between January 2006 and December 2015 were retrospectively analysed. Protocols were revised using Plan Do Check Act cycle. Death and serious adverse events at term were reviewed in six‐monthly quality improvement meetings. Adverse outcome of death or motor/sensory impairments at two years was compared before and after two major protocol changes, which were implemented in January 2008 and January 2012.
Results
Based on the appraisal for period 2006–2007, strategies for surfactant, narcotics, parenteral nutrition, respiratory gas humidity and prophylactic indomethacin and antibiotics were changed for period 2008–2011. For period 2012–2015, stabilisation of infants was accelerated via very early catheterisation. Of 162 infants (84 males, 25.5 ± 1.5 weeks gestation) within the whole cohort, 63 developed adverse outcomes, which were fewer for periods 2008–2011 (p = 0.013) and 2012–2015 (p = 0.035) compared with period 2006–2007 (adjusted for gestational age, Apgar scores and sex).
Conclusion
Careful bottom‐up revisions of protocols using iteration cycles, accounting for local settings, successfully improved the outcomes of preterm infants.</description><subject>Adverse events</subject><subject>Antibiotics</subject><subject>Apgar score</subject><subject>Clinical Protocols</subject><subject>extremely preterm infant</subject><subject>Gestational Age</subject><subject>Humans</subject><subject>Indomethacin</subject><subject>Infant</subject><subject>Infant, Extremely Premature</subject><subject>Infant, Newborn</subject><subject>Infants</subject><subject>intact survival</subject><subject>Male</subject><subject>Narcotics</subject><subject>neonatal intensive care</subject><subject>Neonates</subject><subject>Newborn babies</subject><subject>outcome and Plan Do Check Act cycle</subject><subject>Parenteral nutrition</subject><subject>Premature babies</subject><subject>Pulmonary Surfactants</subject><subject>Quality control</subject><subject>Regular</subject><subject>Regular & Brief Reports</subject><subject>Retrospective Studies</subject><subject>Revisions</subject><issn>0803-5253</issn><issn>1651-2227</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp1kc1qVDEYhoModlpdeAMScNMuTpufk_OzEYax_kDBIroOmZwvndScZExyxh7wYrwWr8zYqUUFs8kiTx7e73sRekbJKS3nTG3VKRVdTR6gBW0ErRhj7UO0IB3hlWCCH6DDlK4JYbyvm8fogPO2_Gv5An37ADubbPAJB4O1s95q5fA2hhx0cAlPyfornDeAL53y-FXAqw3oz3ipM9azdoDtWOgdDDhMWYcRbk1wkyOM4OaiggxxxNYb5XPCKmP24_sMKqYn6JFRLsHTu_sIfXp9_nH1trp4_-bdanlRaVEzUinDiFAtVa3p2JoyVa9bIqAfeK07PQgOrWg4rRugimlhaK-56chgWrPuSNvzI_Ry791O6xEGDT5H5eQ22lHFWQZl5d8v3m7kVdjJjjeENKwIju8EMXyZIGU52qTBlY1AmJJkglDWNKIRBX3xD3odpujLeIWqedfXhJFCnewpHUNKEcx9GErkr05l6VTedlrY53-mvyd_l1iAsz3w1TqY_2-Sy8vlXvkTcyGtXQ</recordid><startdate>202107</startdate><enddate>202107</enddate><creator>Saikusa, Mamoru</creator><creator>Kinoshita, Masahiro</creator><creator>Tsuda, Kennosuke</creator><creator>Hisano, Tadashi</creator><creator>Okada, Junichiro</creator><creator>Iwata, Sachiko</creator><creator>Fujino, Hiroshi</creator><creator>Maeno, Yasuki</creator><creator>Yamashita, Yushiro</creator><creator>Iwata, Osuke</creator><general>Wiley Subscription Services, Inc</general><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7TM</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-9277-1109</orcidid></search><sort><creationdate>202107</creationdate><title>Revisions of clinical protocols using the Plan Do Check Act cycle improved outcomes of extremely preterm infants at 2 years</title><author>Saikusa, Mamoru ; Kinoshita, Masahiro ; Tsuda, Kennosuke ; Hisano, Tadashi ; Okada, Junichiro ; Iwata, Sachiko ; Fujino, Hiroshi ; Maeno, Yasuki ; Yamashita, Yushiro ; Iwata, Osuke</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5420-af205a71a7f82b12a4b705e9d34c8cd53e7563146e1a2c5f19c3f80df7fb80793</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adverse events</topic><topic>Antibiotics</topic><topic>Apgar score</topic><topic>Clinical Protocols</topic><topic>extremely preterm infant</topic><topic>Gestational Age</topic><topic>Humans</topic><topic>Indomethacin</topic><topic>Infant</topic><topic>Infant, Extremely Premature</topic><topic>Infant, Newborn</topic><topic>Infants</topic><topic>intact survival</topic><topic>Male</topic><topic>Narcotics</topic><topic>neonatal intensive care</topic><topic>Neonates</topic><topic>Newborn babies</topic><topic>outcome and Plan Do Check Act cycle</topic><topic>Parenteral nutrition</topic><topic>Premature babies</topic><topic>Pulmonary Surfactants</topic><topic>Quality control</topic><topic>Regular</topic><topic>Regular & Brief Reports</topic><topic>Retrospective Studies</topic><topic>Revisions</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Saikusa, Mamoru</creatorcontrib><creatorcontrib>Kinoshita, Masahiro</creatorcontrib><creatorcontrib>Tsuda, Kennosuke</creatorcontrib><creatorcontrib>Hisano, Tadashi</creatorcontrib><creatorcontrib>Okada, Junichiro</creatorcontrib><creatorcontrib>Iwata, Sachiko</creatorcontrib><creatorcontrib>Fujino, Hiroshi</creatorcontrib><creatorcontrib>Maeno, Yasuki</creatorcontrib><creatorcontrib>Yamashita, Yushiro</creatorcontrib><creatorcontrib>Iwata, Osuke</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Wiley Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Acta Paediatrica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Saikusa, Mamoru</au><au>Kinoshita, Masahiro</au><au>Tsuda, Kennosuke</au><au>Hisano, Tadashi</au><au>Okada, Junichiro</au><au>Iwata, Sachiko</au><au>Fujino, Hiroshi</au><au>Maeno, Yasuki</au><au>Yamashita, Yushiro</au><au>Iwata, Osuke</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Revisions of clinical protocols using the Plan Do Check Act cycle improved outcomes of extremely preterm infants at 2 years</atitle><jtitle>Acta Paediatrica</jtitle><addtitle>Acta Paediatr</addtitle><date>2021-07</date><risdate>2021</risdate><volume>110</volume><issue>7</issue><spage>2100</spage><epage>2109</epage><pages>2100-2109</pages><issn>0803-5253</issn><eissn>1651-2227</eissn><abstract>Aim
Clinical quality improvement is often cumbersome due to established protocols. We aimed to investigate whether outcomes of preterm infants improve with protocol revisions using iteration cycles.
Methods
Preterm infants born <28 weeks gestation between January 2006 and December 2015 were retrospectively analysed. Protocols were revised using Plan Do Check Act cycle. Death and serious adverse events at term were reviewed in six‐monthly quality improvement meetings. Adverse outcome of death or motor/sensory impairments at two years was compared before and after two major protocol changes, which were implemented in January 2008 and January 2012.
Results
Based on the appraisal for period 2006–2007, strategies for surfactant, narcotics, parenteral nutrition, respiratory gas humidity and prophylactic indomethacin and antibiotics were changed for period 2008–2011. For period 2012–2015, stabilisation of infants was accelerated via very early catheterisation. Of 162 infants (84 males, 25.5 ± 1.5 weeks gestation) within the whole cohort, 63 developed adverse outcomes, which were fewer for periods 2008–2011 (p = 0.013) and 2012–2015 (p = 0.035) compared with period 2006–2007 (adjusted for gestational age, Apgar scores and sex).
Conclusion
Careful bottom‐up revisions of protocols using iteration cycles, accounting for local settings, successfully improved the outcomes of preterm infants.</abstract><cop>Norway</cop><pub>Wiley Subscription Services, Inc</pub><pmid>33711173</pmid><doi>10.1111/apa.15840</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-9277-1109</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adverse events Antibiotics Apgar score Clinical Protocols extremely preterm infant Gestational Age Humans Indomethacin Infant Infant, Extremely Premature Infant, Newborn Infants intact survival Male Narcotics neonatal intensive care Neonates Newborn babies outcome and Plan Do Check Act cycle Parenteral nutrition Premature babies Pulmonary Surfactants Quality control Regular Regular & Brief Reports Retrospective Studies Revisions |
| title | Revisions of clinical protocols using the Plan Do Check Act cycle improved outcomes of extremely preterm infants at 2 years |
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