Enhancing Safe Sleep Counseling by Pediatricians through a Quality Improvement Learning Collaborative

Abstract

Background: Approximately, 3,500 infants die annually from sleep-related infant deaths in the United States. We sought to improve pediatricians’ counseling on safe sleep from birth through 6 months of age through a virtual quality improvement learning collaborative (QILC). Our aim was appropriate screening, counseling, and documentation of safe sleep advice in 75% of eligible patient encounters after the QILC. Methods: We formed a 9-month QILC for inpatient and outpatient pediatricians. Pediatricians collected data on safe sleep documentation in a newborn discharge or well-child visit note. Data were submitted at baseline and in 9 subsequent phases. Participants met monthly via a webinar, which included a QI presentation, data review, and facilitated discussion among participants. Practices were contacted 12 months after the conclusion of the QILC to assess sustainment. Results: Thirty-four pediatricians from 4 inpatient and 9 outpatient practices participated in the QILC. At baseline, documentation of safe sleep practices varied greatly (0%–98%). However, by the end of the QILC, all participating practices were documenting safe sleep guidance in over 75% of patient encounters. Aggregate practice data show a significant, sustained improvement. The 12-month follow-up data were submitted from 62% of practices, with sustainment of improvement in 75% of practices. Conclusion: A facilitated, virtual QILC is an effective methodology to improve safe sleep counseling among a diverse group of pediatric practices. It is one step in improving consistent messaging around safe sleep by healthcare providers as pediatricians work to decrease sleep-related infant deaths.

Virtual quality improvement collaborative with primary care practices during COVID-19: a case study within a clinically integrated network

“…Representatives from seven clinic sites participated in bimonthly meetings for 12 months and received clinic-specific coaching on closing gaps in quality measures. Similar to other virtual QICs,15 24–26 participants found the web-based modality acceptable and useful.…”

Improving Safety through a Virtual Learning Collaborative

“…18 Scott et al also demonstrated that a facilitated, virtual quality improvement learning collaborative was an effective way to improve safe sleep counseling among a diverse group of pediatric practices. 19…”

Practicing What We Preach: An Effort to Improve Safe Sleep of Hospitalized Infants

“…Scott et al demonstrated that a quality improvement collaborative improves screening, counseling, and documentation of anticipatory guidance during newborn nursery and primary care visits. 22 A similar approach could improve screening and education for at-risk infants in the hospital setting. Further research is needed to determine if an optimal implementation strategy could be generalized across institutions, perhaps by combining the most successful aspects of several different care bundles.…”

“…While safe sleep education should occur during prenatal and infant primary care visits, additional education and modeling in the hospital setting may reinforce safe sleep practices at home. The Infant Care Practices Study demonstrated that maternal adherence to a safe sleep environment declines over time, measured at 1 month, 3 months, and 6 months postdelivery, 23 suggesting that postnatal education and modeling could influence the sleep environment. In addition, a safe sleep bundle in the NICU can improve safe sleep environments for hospitalized infants and improve the sleep environment postdischarge.…”