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2. Adherence to and outcomes of a University-Consortium gastroschisis pathway

Author

Daniel A. DeUgarte, Kara L. Calkins, Yigit Guner, Jae Kim, Karen Kling, Katelin Kramer, Hanmin Lee, Leslie Lusk, Payam Saadai, Cherry Uy, Catherine Rottkamp, Jamie Anderson, Aubrey Blanton, Nina Boe, Erin Brown, Michael Choy, Raymond Dougherty, Diana Farmer, Nancy Field, Laura Galganski, Hedriana Herman, Shinjiro Hirose, Gina James, Elyse Love, John McGahan, Amelia McLennan, Giselle Melendres, Francis Poulain, Amy Powne, Gary Raff, Laila Rhee Morris, David Schrimmer, Simran Sekhohn, Sherzana Sunderji, Veronique Tache, Melissa Vanover, Jay Yeh, M Baraa Allaf, Katie Bacca, Elizabeth Blumenthal, Kari Bruce, Lisa Carroll, Robert Day, Jennifer Duffy, David Gibbs, Afshan Hameed, Tamara Hatfield, Alexandra Iacob, Jennifer Jolley, Mustafa Kabeer, Nafiz Kiciman, Nancy Lee, Carol Major, Joshua Makhoul, Yona Nicolau, Elizabeth Patberg, Christina Penfield, Manuel Porto, Pamela Rumney, Valeria Simon, Lizette Spiers, Melissa Westermann, Peter Yu, Kara Calkins, Judith Chung, Ilina Datkhaeva, Daniel DeUgarte, Uday Devaskar, Jaime Deville, Rachel Gutkin, Carla Janzen, Howard Jen, Daniel Kahn, Suhas Kallapur, Steven Lee, Steven Lerman, Melanie Maykin, Aisling Murphy, Tina Nguyen, Victoria Niklas, Rashmi Rao, Gary Satou, Emily Scibetta, Mark Sklansky, Rebecca Stark, Katie Strobel, Renea Sturm, Khalil Tabsh, Afshar Yalda, Rebecca Adami, Laith Alshawabkeh, Tracy Anton, Jerasimos Ballas, Stephen Bickler, Divya Chhabra, Charlotte Conturie, Erika Fernandez, Aileen Fernando, Neil Finer, Andrew Hull, Diana Johnson, Leah Lamale-Smith, Louise Laurent, Frank Mannino, Dora Melber, Mishella Perez, Andrew Picel, Dolores Pretorius, Sandy Ramos, Diana Sanford, Maryam Tarsa, Vy Tran, Douglas Woelkers, Kathy Zhang-Rutledge, Katie Archbold, Victoria Berger, Paul Brakeman, Melissa Catenacci, Shilpa Chetty, Hillary Copp, Emily Edwards, Vickie Feldstein, Neda Ghaffari, Ruth Goldstein, Juan Gonzalez, Kristen Gosnell, Joanne Gras, Michael Harrison, Whitnee Hogan, Romobia Hutchinson, Roxanna Irani, Priyanka Jha, Roberta Keller, Maureen Kohi, Katherine Kosiv, Katie Kramer, Billie Lianoglou, Jennifer Lucero, Tippi MacKenzie, Anne Mardy, Erin Matsuda, Edward Miller, Anita Moon-Grady, Tara Morgan, Amy Murtha, Mary Norton, Natalie Oman, Benjamin Padilla, Shabnam Peyandi, Andrew Phelps, Liina Poder, Annalisa Post, Larry Rand, Naseem Rangwala, Frederico Rocha, Mark Rollins, Melissa Rosenstein, Janice Scudmore, Rachel Shulman, Dorothy Shum, Teresa Sparks, Jeffrey Sperling, Katherine Swanson, Martha Tesfalul, Stephanie Valderramos, Lan Vu, Amanda Yeaton-Massey, Lisa Arcilla, Stacie Bennett, Erin Corbett, and Howard Rosenfeld

Subjects
medicine.medical_specialty, medicine.medical_treatment, Cohort Studies, Hospitals, University, 03 medical and health sciences, 0302 clinical medicine, Clinical pathway, 030225 pediatrics, medicine, Humans, Intubation, Gastroschisis, Mechanical ventilation, Wound Closure Techniques, business.industry, Infant, Newborn, General Medicine, Evidence-based medicine, Length of Stay, medicine.disease, Respiration, Artificial, Discontinuation, Treatment Outcome, 030220 oncology & carcinogenesis, Practice Guidelines as Topic, Pediatrics, Perinatology and Child Health, Cohort, Emergency medicine, Surgery, Guideline Adherence, business, Historical Cohort
Abstract

Our multi-institutional university consortium implemented a gastroschisis pathway in 2015 to standardize and improve care by promoting avoidance of routine intubation and paralysis during silo placement, expeditious abdominal wall closure, discontinuation of antibiotics/narcotics within 48 h of closure, and early initiation/advancement of feeds.Adherence to the gastroschisis pathway was prospectively monitored. Outcomes for the contemporary cohort (2015-2018) were compared with a historical cohort (2007-2012).Good adherence to the pathway was observed for 70 cases of inborn uncomplicated gastroschisis. The contemporary cohort had significantly lower median mechanical ventilator days (2 versus 5; p 0.01) and antibiotic days (5.5 versus 9; p 0.01) as well as earlier days to initiation of feeds (12 versus 15; p 0.01). However, no differences were observed in length of stay (28 versus 29 days; p = 0.70). A skin closure technique was performed in 66% of the patients, of which 46% were performed at bedside without intubation, the assistance of an operating-room team, or general anesthesia.In this study, adherence to a clinical pathway for gastroschisis across different facilities was feasible and led to reduction in exposure to mechanical ventilation and antibiotics. The adoption of a bedside skin closure technique appears to facilitate compliance with the pathway.Level II/III TYPE OF STUDY: Prospective comparative study with historical cohort.

Published
2020

3. Growth Failure Prevalence in Neonates with Gastroschisis : A Statewide Cohort Study

Author

Katie M. Strobel, Tahmineh Romero, Katelin Kramer, Erika Fernandez, Catherine Rottkamp, Cherry Uy, Roberta Keller, Laurel Moyer, Francis Poulain, Jae H. Kim, Daniel A. DeUgarte, Kara L. Calkins, Nina Boe, Erin Brown, Diana Farmer, Nancy Field, Herman Hedriana, Shinjiro Hirose, Gina James, Elyse Love, Amelia McLennan, Amy Powne, Laila Rhee Morris, Payam Saadai, Sherzana Sunderji, Veronique Tache, Jay Yeh, M. Baraa Allaf, Katie Bacca, Lisa Carroll, Brian Crosland, Robert Day, Jennifer Duffy, David Gibbs, Afshan Hameed, Tamara Hatfield, Alexandra Iacob, Jennifer Jolley, Mustafa Kabeer, Nafiz Kiciman, Nancy Lee, Carol Major, Joshua Makhoul, Yona Nicolau, Manuel Porto, Rebecca Post, Pamela Rumney, Lizette Spiers, Peter Yu, Irfan Ahmad, Nita Doshi, Yigit Guner, Wyman Lai, Pierangelo Renella, Yalda Afshar, Kara Calkins, Ilina Pluym, Daniel DeUgarte, Uday Devaskar, Jaime Deville, Viviana Fajardo, Meena Garg, Christina Han, Kerry Holliman, Carla Janzen, Howard Jen, Suhas Kallapur, Steven Lee, Steven Lerman, Aisling Murphy, Tina Nguyen, Rashmi Rao, Animesh Sabnis, Gary Satou, Mark Sklansky, Katie Strobel, Renea Sturm, Khalil Tabsh, Thalia Wong, Rebecca Adami, Tracy Anton, Jerasimos Ballas, Stephen Bickler, Andrew Hull, Marni Jacobs, Diana Johnson, Karen Kling, Leah Lamale-Smith, Sarah Lazar, Louise Laurent, Tzu-Ning Liu, Celestine Magallanes, Dora Melber, Mana Parast, Mishella Perez, Dolores Pretorius, Sandy Ramos, Maryam Tarsa, Douglas Woelkers, Kathy Zhang-Rutledge, Ian Fraser Golding, Heather Sun, Katie Archbold, Lisa Arcilla, Stacie Bennet, Paul Brakeman, Melissa Catenacci, Shilpa Chetty, Hillary Copp, Erin Corbett, Valerie Dougherty, Sarah Downum, Vickie Feldstein, Neda Ghaffari, Ruth Goldstein, Juan Gonzalez-Velez, Veronica Gonzalez, Kristen Gosnell, Joanne Gras, Michael Harrison, Whitnee Hogan, Romobia Hutchinson, Roxanna Irani, Priyanka Jha, Erna Josiah-Davis, Hanmin Lee, Billie Lianoglou, Jennifer Lucero, Leslie Lusk, Tippi MacKenzie, Anne Mardy, Erin Matsuda, Anita Moon-Grady, Tara Morgan, Amy Murtha, Mary Norton, Natalie Oman, Benjamin Padilla, Sachi Patel, Shabnam Peyandi, Andrew Phelps, Liina Poder, Annalisa Post, Larry Rand, Diana Robles, Frederico Rocha, Howard Rosenfeld, Melissa Rosenstein, Janice Scudmore, Dorothy Shum, Nasim Sobhani, Teresa Sparks, Katherine Swanson, Martha Tesfalul, Stephanie Valderramos, Lan Vu, and Amanda Yeaton-Massey

Subjects
Male, Pediatrics, medicine.medical_specialty, Standard score, Linear Growth Failure, California, Article, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Prevalence, medicine, Hospital discharge, Humans, 030212 general & internal medicine, Growth Disorders, Retrospective Studies, Gastroschisis, Fetus, business.industry, Body Weight, Infant, Newborn, Gestational age, medicine.disease, Body Height, Multicenter study, Pediatrics, Perinatology and Child Health, Female, business, Cohort study
Abstract

OBJECTIVES: To perform a multicenter study to assess growth failure in hospitalized infants with gastroschisis. STUDY DESIGN: This study included neonates with gastroschisis within sites in the University of California Fetal Consortium (UCFC). The study’s primary outcome was growth failure at hospital discharge, defined as a weight or length z-score decrease > 0.8 from birth. Regression analysis was performed to assess changes in z-scores over time. RESULTS: Among 125 infants with gastroschisis, the median gestational age was 37 weeks (IQR 35–37). Length of stay was 32 days (23–60); 55% developed weight or length growth failure at discharge (28% had weight growth failure, 42% had length growth failure, and 15% had both weight and length growth failure). Weight and length z-scores at 14 d, 30 d, and discharge were less than birth (p

Published
2021

4. Interprofessional Approach to the Sustained

Author

Cheryl Lynne, McBeth, Rosa Solis, Montes, Amy, Powne, Sopon Elizabeth, North, and JoAnne E, Natale

Subjects
Adult, Male, Critical Care, Health Personnel, Interprofessional Relations, Pneumonia, Ventilator-Associated, Middle Aged, Intensive Care Units, Pediatric, Practice Guidelines as Topic, Intubation, Intratracheal, Humans, Education, Medical, Continuing, Female, Curriculum
Abstract

Ventilator-associated pneumonia (VAP) increases morbidity, mortality, and health care costs.To reduce the VAP rate in the pediatric/cardiac intensive care unit to fewer than 2 events per 1000 ventilator days within 2 years and to sustain a rate near 0 for the next 5 years.An evidence-based VAP prevention bundle was developed and implemented by an interprofessional team using the Six Sigma Define, Measure, Analyze, Improve, Control methodology. The mixed unit's 5-element VAP prevention bundle consisted of age-appropriate oral care, proper airway suction technique, maintenance of safe endotracheal-tube cuff pressures, aspiration precautions, and head-of-bed elevation. Knowledge and practice were reinforced through multidisciplinary education and one-on-one teaching. Practice compliance was monitored through regular, unannounced bedside audits linked to just-in-time teaching.Within 2 years, the annual VAP rate fell from 7.86 to 1.16 events per 1000 ventilator days; VAP bundle-element compliance ranged from 86% to 99%. There were no VAP events during a 10-quarter period in 2012 through 2014.Development, implementation, and revision of a VAP prevention strategy using the Define, Measure, Analyze, Improve, Control methodology was associated with marked, sustained reduction in VAP rates, notably during the unit's expansion from 16 to 24 beds, the opening of a pediatric cardiothoracic unit, and the hiring of more than 80 new nurses. After 7 years, the VAP rate continues to be low at 0.86 for 2016 and 0 through June 2017.

Published
2018

5. Implementation of Five-element, Interprofessional Ventilator-associated Pneumonia Prevention Bundle in the Pediatric Intensive Care Unit

Author

Cheryl McBeth, Rosa Montes, Eunice Butler, Amy Powne, JoAnne E Natale, and Alberto Amezquita

Subjects
Pediatric intensive care unit, medicine.medical_specialty, Quality management, business.industry, Psychological intervention, Ventilator-associated pneumonia, bacterial infections and mycoses, medicine.disease, respiratory tract diseases, Pneumonia, Bundle, Hospital-acquired infection, Emergency medicine, Health care, Pediatrics, Perinatology and Child Health, medicine, business
Abstract

Background: Ventilator-associated pneumonia (VAP), a leading cause of hospital acquired infection, increases morbidity, mortality and health care costs. Local problem: With a VAP rate at four times the National Healthcare Safety Network (NHSN) benchmark, the goal of this quality improvement project was to develop and implement a VAP prevention bundle to sustainably reduce VAP rate in a pediatric ICU to below NHSN benchmark over 5 years. Methods and interventions: Patient population included all patients …

Published
2018

6. Interprofessional Approach to the Sustained Reduction in Ventilator-Associated Pneumonia in a Pediatric Intensive Care Unit.

Author

McBeth CL, Montes RS, Powne A, North SE, and Natale JE

Subjects
Adult, Curriculum, Education, Medical, Continuing, Female, Humans, Male, Middle Aged, Critical Care standards, Health Personnel education, Intensive Care Units, Pediatric standards, Interprofessional Relations, Intubation, Intratracheal adverse effects, Pneumonia, Ventilator-Associated prevention & control, Practice Guidelines as Topic
Abstract

Background: Ventilator-associated pneumonia (VAP) increases morbidity, mortality, and health care costs., Objective: To reduce the VAP rate in the pediatric/cardiac intensive care unit to fewer than 2 events per 1000 ventilator days within 2 years and to sustain a rate near 0 for the next 5 years., Methods: An evidence-based VAP prevention bundle was developed and implemented by an interprofessional team using the Six Sigma Define, Measure, Analyze, Improve, Control methodology. The mixed unit's 5-element VAP prevention bundle consisted of age-appropriate oral care, proper airway suction technique, maintenance of safe endotracheal-tube cuff pressures, aspiration precautions, and head-of-bed elevation. Knowledge and practice were reinforced through multidisciplinary education and one-on-one teaching. Practice compliance was monitored through regular, unannounced bedside audits linked to just-in-time teaching., Results: Within 2 years, the annual VAP rate fell from 7.86 to 1.16 events per 1000 ventilator days; VAP bundle-element compliance ranged from 86% to 99%. There were no VAP events during a 10-quarter period in 2012 through 2014., Conclusions: Development, implementation, and revision of a VAP prevention strategy using the Define, Measure, Analyze, Improve, Control methodology was associated with marked, sustained reduction in VAP rates, notably during the unit's expansion from 16 to 24 beds, the opening of a pediatric cardiothoracic unit, and the hiring of more than 80 new nurses. After 7 years, the VAP rate continues to be low at 0.86 for 2016 and 0 through June 2017., (©2018 American Association of Critical-Care Nurses.)

Published
2018
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