The Development of a Group B Streptococcus Prevention Policy at a Community Hospital

Clemens, Conrad J.; Gable, Elizabeth K.aye

doi:10.1038/sj.jp.7210794

Cited by 6 publications

(8 citation statements)

References 8 publications

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“…We identified six studies that evaluated interventions to improve healthcare quality for neonates in community hospitals; two involved telemedicine 43‐48 . Hall et al described “Telenursery,” a program linking regional perinatal centers with a large academic neonatal practice through real‐time teleconferencing, in addition to providing weekly educational conferences 45 .…”

Section: Resultsmentioning

confidence: 99%

“…In a similar study, Sable et al found that a videoconferencing system for cardiologists from an academic center to guide care in a community setting provided diagnostic services more quickly (28 minutes vs 12 hours) and had high diagnostic accuracy 47 . The remaining four studies evaluated heterogeneous interventions such as a maternal education program to reduce shaking injuries to infants or implementation of evidence‐based order sets to reduce early onset group B streptococcal disease in neonates 43,44,46,48 . Five of the six neonatal studies demonstrated improved quality outcomes after intervention 43‐47 …”

Section: Resultsmentioning

confidence: 99%

“…Our search identified only 14 studies evaluating QI interventions within community hospitals over the almost 30‐year review period. Although limited in number, 86% of these demonstrated improvements in healthcare quality and safety, providing a positive “proof of concept” that pediatric care in community hospitals can be improved by multidisciplinary efforts and be sustained over time 43‐47,49,51‐56 . As pediatric departments within community hospitals may have limited resources, aligning pediatric QI efforts with adult initiatives within the same hospitals could prove advantageous.…”

Section: Discussionmentioning

confidence: 99%

“…43,44,46,48 Five of the six neonatal studies demonstrated improved quality outcomes after intervention. [43][44][45][46][47]…”

Section: Neonatal Medicinementioning

confidence: 99%

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Quality and Safety of Pediatric Inpatient Care in Community Hospitals: A Scoping Review

Leary

Walsh

Morin

et al. 2019

Journal of Hospital Medicine

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D espite efforts to provide high-quality healthcare, Americans die from medical errors each year and many patients do not receive recommended medical care. Risk is particularly acute during times of hospitalization. [1][2][3][4] In response, the Institute of Medicine (IOM, now the Academy of Medicine) has released "Crossing the Quality Chasm: A New Health System for the 21 st Century," providing a framework to guide delivery and measurement of high-quality healthcare. 5 Although the IOM framework has motivated the development of quality improvement (QI) and quality measurement initiatives, relatively few resources have been allocated to im-proving the quality of pediatric inpatient care. 6,7 The resultant gap in our knowledge of quality and safety of pediatric hospital-based care is further widened by the variability of settings in which children are hospitalized. These settings include freestanding children's hospitals, children's hospitals nested within larger hospitals, and community hospitals, defined as general, nonuniversity, and nonchildren's hospitals. 8 Although almost three-quarters of children needing hospitalization are cared for outside of freestanding children's hospitals, we know particularly little about the quality and safety of pediatric hospital-based care outside of these settings. 6,9 Therefore, our scoping review aims to summarize literature regarding the quality and safety of pediatric inpatient care within community hospitals. METHODSWe used a scoping review approach because this methodology, by design, is utilized to synthesize evidence and map existing literature and is particularly useful when a body of literature is heterogeneous, rendering a more targeted systematic re-

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…43,44,46,48 Five of the six neonatal studies demonstrated improved quality outcomes after intervention. [43][44][45][46][47]…”

Section: Neonatal Medicinementioning

confidence: 99%

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Quality and Safety of Pediatric Inpatient Care in Community Hospitals: A Scoping Review

Leary

Walsh

Morin

et al. 2019

Journal of Hospital Medicine

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“…Effective compliance strategies have been described in large university-affiliated centers, 7 community hospitals without academic affiliation 8 and in health maintenance organizations. 9 Systemwide factors that contributed to successful implementation of a GBS prevention protocol included: physician-leaders as catalysts for protocol presentation and implementation, provider education through meetings and mass mailings, and preprinted order forms that specifically address GBS colonization and antibiotic prophylaxis.…”

mentioning

confidence: 99%

Prevention of Early-onset GBS Sepsis: Evaluation of a Changing Paradigm

Brozanski

2003

J Perinatol

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Prevention of neonatal sepsis caused by group B streptococcus (GBS) is the goal of current, prophylactic strategies. A recent population-based surveillance study has shown that antepartum screening for GBS was 50% more effective than the risk-based approach at preventing perinatal GBS.1 This study led to the updated guidelines published by the CDC, which provide recommendation for universal prenatal culture-based screening for GBS colonization as well as instruction on specimen collection, culture processing, and susceptibility testing and prophylaxis regimens for women with penicillin allergy. 2Coincident with active prevention efforts in the 1990's, the incidence of early-onset GBS decreased from two to three cases per 1000 live births to 0.5 cases per 1000 live births (1). In this issue of the Journal of Perinatology, studies by Riley et al.3 as well as Pinto et al. 4 evaluated the effectiveness of and residual problems associated with the culture-based and risk-based GBS prevention strategies.Riley et al. 3 examined compliance with intrapartum antibiotic prophylaxis, which they found to be dependent on the practice setting and the prevention strategy employed. Several of the problems they identified will no longer be an issue when birthing centers replace the risk-based strategy with the culture-based GBS prevention strategy. In Riley's study, for those women managed with the culture-based strategy, almost 10% failed to have documentation of GBS screening-culture results at the time of delivery and up to 6% of the GBS screening cultures were obtained in the first trimester. Of women whose screening cultures were positive for GBS, 30 to 46% were treated with antibiotics for less than the optimal 4 hours before delivery. In Riley's estimation, 50% of those women could have received antibiotics at least 4 hours before delivery. These authors recommended that patient education about GBS screening-culture results and strict attention to maternal GBS culture status upon presentation in labor would improve compliance with antibiotic administration within 4 hours of delivery.Pinto et al. 4 reviewed 94 cases of early-onset GBS admitted to two regional level III NICUs from 07/92 through 12/01. Of these infants, 50 (53%) were born to women whose GBS colonization status was (i) unknown and who had no identified risk factors or (ii) whose GBS screening culture was reported as negative. The majority of missed opportunities for appropriate administration of intrapartum antibiotics were attributed to: failure to perform or faulty performance of cultures, unreliable culture results, and antibiotic administration for less than 4 hours before delivery.Few studies to date have evaluated implementation and efficacy of CDC protocol for management of infants born to women colonized with GBS. Pinto recommends further evaluation of adjunctive postnatal prophylaxis, which in reality would represent early treatment. 4 In his cohort, such postnatal ''prophylaxis'' would not have been effective, as disease presented clinically at 2.1±1....

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Intrapartum antibiotic prophylaxis to prevent Group B streptococcal infections in newborn infants: a systematic review and meta-analysis comparing various strategies

Panneflek,

Hasperhoven,

Chimwaza

et al. 2024

eClinicalMedicine

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The Development of a Group B Streptococcus Prevention Policy at a Community Hospital

Cited by 6 publications

References 8 publications

Quality and Safety of Pediatric Inpatient Care in Community Hospitals: A Scoping Review

Quality and Safety of Pediatric Inpatient Care in Community Hospitals: A Scoping Review

Prevention of Early-onset GBS Sepsis: Evaluation of a Changing Paradigm

Intrapartum antibiotic prophylaxis to prevent Group B streptococcal infections in newborn infants: a systematic review and meta-analysis comparing various strategies

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