From reducing complications to streamlining workflows, quality improvement (QI) projects are driving meaningful change across healthcare. In this issue, we spotlight five impactful QI initiatives that are helping teams deliver safer, more efficient, and more effective care.

Bronchopulmonary dysplasia (BPD) and chronic lung disease (CLD) remain among the most pressing challenges in the NICU, leading this team to launch a multidisciplinary initiative to drive lasting change.

“Improvement strategies focused on addressing the primary drivers of ventilation strategies, surfactant administration, non-invasive ventilation, medication use, and nutrition/fluid management”

“Overall CLD rate decreased from 33.5% to 16.5%, a 51% reduction that has been sustained for >18 months”

Following a rise in pediatric discharges on noninvasive ventilation for sleep-disordered breathing and respiratory failure, a QI plan was implemented to optimize the effectiveness of interventions.

Developed a standardized process that includes early identification and tracking, improved communication using tools within the EMR, and facilitated transition from in patient to outpatient teams.

“[The measures above] have improved outpatient follow up and kept readmissions down, thereby improving efficiency of practice and patient safety.”

The team at Henry Ford Health aimed to assess compliance with lung protective ventilation (tidal volumes within 6-8ml/kg of ideal body weight) in their medical intensive care unit (MICU).

“A retrospective analysis was conducted of 63 patients who were intubated looking at initial set tidal volumes. Any patients with tidal volumes not set within 6-8ml/kg of IBW were identified as those with areas of improvement.”

“Comparing pre-intervention and post-intervention data, education of learners and QR codes demonstrated a measurable increase in utilization of lung protective strategies in patients on invasive mechanical ventilation.”

To reduce rates of severe intracranial hemorrhage (ICH) and early mortality in extremely premature infants, this NICU focused on implementing evidence-based care bundles during the critical first week of life in a two-phase initiative from 2014-2020.

Phase One:
In the first phase (2015–2016), staff were trained on new care guidelines, used checklists, improved communication, and worked closely with obstetric teams. They standardized delivery room care, adjusted fluid and medication use, and introduced transcutaneous carbon dioxide (CO₂) monitoring right after birth to better track breathing. A training program called the Golden Week Program was launched to teach gentle handling.

Phase Two:
In the second phase (starting in 2016), the hospital added electronic order sets, better heart monitoring, more frequent weight and fluid checks, and a special care team. They also switched to a new ventilator strategy in 2019.

“We studied 820 infants with a mean gestational age of 25 + 3/7 weeks and median birth weight of 744 g. The rate of severe ICH or death in the first week after birth decreased from the baseline rate of 27.4% to 15.0%. The rate of severe ICH decreased from a baseline rate of 16.4% to 10.0%.”

This NICU team launched a quality improvement initiative to identify the root causes of unplanned extubations and implement strategies to reduce their occurrence.

“Our QI initiative focused on implementing a systematic approach that would include formalizing documentation and data collection on these events, standardizing endotracheal tube taping procedures, and developing a debrief guide to analyze each unplanned extubation event.”

“Through the QI initiative, we saw significant improvements. The number of UE events declined from 80 in 2019 to 10 in 2022, and we achieved a sustained reduction of UEs to <1 per 100 ventilator days. The most impactful interventions were attributed to multidisciplinary engagement and active involvement of our medical trainees, the development of a standardized care bundle, and the creation of the debrief guide.”