Never judge a book by its cover: how NICU evaluators reach conclusions about quality of care

An Observational Time Study of Neonatal Intensive Care Unit Multidisciplinary Rounds

OBJECTIVE

In this observational study, we aimed to describe the rounding structure in a high acuity neonatal intensive care unit (NICU) to identify potential barriers to efficient multidisciplinary rounds.

STUDY DESIGN

We observed daily medical rounds (January-December 2018) on the resident teaching service in a 46-bed academic level IV NICU. Daily census, duration of rounds, and causes for rounding delays were recorded. During a subset of the study period, additional data were collected describing the time spent on specific activities and the room-to-room pathway followed by the rounding team. Descriptive statistics were used to summarize the census, total rounding time, time spent on each activity, and rounding time by day of the week and by attending.

RESULTS

A total of 208 rounding days were observed. During the study period, the teaching service mean daily census was 17 patients and total rounding time (mean ± standard deviation) was 136 ± 31 minutes. Mean rounding time and time/patient varied between the nine attendings (total time range 109 minutes to 169 minutes, time/patient range 6.4 minutes/patient to 10.0 minutes/patient). In total, 91% of rounding time focused on patient care, teaching, and discussions with parents, while 9% of the time was spent deciding which patient to see next, moving between rooms, and waiting for members of the team to be ready to start rounds.

CONCLUSION

On average, the medical team spent over 2 hours per day making multisciplinary rounds in the NICU with substantial variation between attending providers. While most time was spent on patient care, teaching, and talking with parents, we identified opportunities to improve rounding efficiency.

KEY POINTS

· The structure of rounds in a NICU was observed to identify the potential barriers to efficiency.. · There are limited data on MDR processes in the NICU.. · In total, 9% of time was spent on patient care activities during daily rounds..

Building the First Statewide Quality Improvement Collaborative, the CPQCC: A Historic Perspective

The California Perinatal Quality Improvement Collaborative (CPQCC), founded in 1997, was the country’s first statewide perinatal quality improvement collaborative. Our goal was to improve the quality and outcomes of perinatal healthcare in California by developing a collaborative network of public and private obstetric and neonatal providers, insurers, public health professionals, and business groups to support a system for benchmarking and performance improvement activities for perinatal care. In this presentation, we describe how viewing the CPQCC as a complex value-driven organization, committed to identifying and addressing the needs of both its stakeholder partners and neonatal intensive care unit (NICU) members, has shaped the course of its development.