A Multicenter Initiative for Critical Congenital Heart Disease Newborn Screening in Texas Neonatal Intensive Care Units

Abstract

The objective of this study was to implement a strategy for critical congenital heart disease (CCHD) newborn screening in the neonatal intensive care unit (NICU). A NICU-specific curriculum, screening algorithm, slide presentations, and templates of orders, policies, and procedures were developed into a toolkit for training NICU personnel. Screening was conducted on first and second screen pre- and postductal oxygen saturations (SpO) on newborns admitted or transferred to the NICU. We trained 347 NICU personnel in 13 Texas hospitals, representing rural, suburban, and metropolitan settings. Key hospital staff submitted deidentified, case-based screening data. Of 4,621 NICU admissions, 80% received a first screen. Second screening rates were substantially lower in all gestational age groups. Screening rates on first and second screens were lowest among infants born< 28 weeks. For the first screen, SpO was lowest among the youngest gestational ages. The false positive rate was 2.3%. CCHD screening in the NICU is challenging, given the complexities of the NICU population. A modified screening protocol that recognizes special circumstances of neonatal intensive care could facilitate a more efficient system.

Spread tools: a systematic review of components, uptake, and effectiveness of quality improvement toolkits

“…Use of the timed 25-foot walk test increased from 25 to 46% ( p < .001), use of clinic questionnaire for spasticity improved from 3 to 9% ( p < .001). Use of behavioral modifications, pharmacotherapy, and physical therapy remained unchanged Patients : NRGuillory 2017 [66]USNewborn screeningHospitals# hospitals: 13# providers: 117 physicians, hospital administrators, and other health care professionals, 215 nurses# patients: 11322Pre-postCritical Congenital Heart Deiseas (CCHD) Toolkit Implementation : PP presentation for physicians, PP presentation for nurses, sample nursery policy, Taryn's Story (4 minute video script), Lifesaving Newborn Screen (30 s PSA script) Provider : Algorithm card, sample physician order, sample screening log, wall poster for newborn nursery Patient : Brochure (English/Spanish) for positive screen, brochure (English/Spanish) for families Other intervention : A hospital nurse champion (HNC) was identified for each facility to serve as a leader, with responsibilities of training personnel, facilitating implementation, and identifying and addressing barriers. Nurse educators and HNCs conducted an accredited, 1-hour training session at each hospital to ensure standardization of education for the newborn nursing staff. Uptake : NR Feasibility : NR Providers : The pretest average was 71% and improved to 92.5% ( p < .0001).…”

“…Studies did not separate effects of toolkits versus other intervention elements when these were present. With some exceptions [18, 21, 26, 32, 34, 43, 48, 50, 60, 63, 65, 66, 68, 70, 73, 76, 78, 88], provider effects were studied using post only designs such as asking providers to describe the effects of the toolkit.…”

“…Three studies tested provider knowledge; one found no difference in general concussion knowledge between intervention and control groups but intervention physicians were less likely to recommend next day return to play after concussion [18]. A congenital heart disease toolkit improved knowledge (pretest average score 71% improved to 93%, p < .0001) [66], and one study documented that only three of the ten knowledge-based questions were answered correctly by more than 85% of participants on the pre-test but all ten questions were answered correctly by at least 95% of participants on the post-test after implementing a patient safety toolkit [88]. One study reported that adherence to targeted provider behaviors increased significantly for 62% of behaviors but not for counselor competence [50].…”

“…We identified 22 studies (29% of all included studies) that reported on patient outcomes, the primary outcome of the review. While some studies reported on patient health [10, 28, 33, 40, 44, 45, 52, 55, 57, 61, 77, 78, 84, 87], others reported on patient satisfaction with the toolkit or individual tools [26, 48, 64, 79, 85], or other patient outcomes such as satisfaction with care processes [60, 66, 86].…”

Quality Improvement Interventions to Improve Critical Congenital Heart Disease Screening

“…In one Texas multi-institution study, between 46.3% and 80% of infants were missed depending on screening characteristics of the infant (with the most premature group of less than 28 weeks being the least protocol compliant). 17 An NICU-specific multicenter collaborative found that the number of infants not screened according to the protocol was approximately 1.1%. 18…”