Building a NICU Quality & Safety Infrastructure

Quality and safety are integral components of healthcare. Importantly, quality of care is an intrinsic component of the numerator for the value equation, which defines value as health outcomes achieved per dollar spent.1 In the Newborn Intensive Care Unit (NICU), improving outcomes and reducing harm is possible using rigorous quality improvement (QI) methodology and by creating a reliable patient safety culture. Examples of these achievements include lower rates of central-line associated blood stream infection (CLABSI), decreases in postnatal growth failure, and decreases in admission hypothermia.2, 3, 4

Clinical leaders are often responsible for leading quality and safety activities in the NICU, yet many lack formal training for these role-specific responsibilities.5 Recognizing this gap, and harnessing the collaborative expertise of medical directors and quality leaders, the Section on Neonatal Perinatal Medicine (SONPM) supported the creation of a special interest group designed to serve these clinical leaders. This group is the Clinical Leaders Group (CLG) which at the time of publication has over 500 members who utilize a collaborative listserv and participate in workshops covering leadership related objectives and concepts.

The American Academy of Pediatrics (AAP) Standards for Levels of Neonatal Care highlights key components of a Neonatal Patient Safety and Quality Improvement Program (NPSQIP), underscoring the importance of quality and safety programs in the NICU.6 Based on the NPSQIP standards, the SONPM CLG developed a curriculum to guide teams who are building their NICU quality and safety infrastructure (QSI). This curriculum, originally delivered over a series of four virtual workshops from 2022-2023, is based on foundational domains of a successful QSI: quality improvement, quality assurance, safety culture, and clinical guidelines. This paper serves as an operational reference for NICU clinical leaders and quality champions to navigate these domains and develop a local QSI to reflect the AAP NPSQIP standards.

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