The Association of Organizational Culture and Quality Improvement Implementation With Neonatal Outcomes in the NICU.

Introduction: Studies of adult patient populations suggest that organizational culture is associated with quality improvement (QI) implementation, as well as patient outcomes. However, very little research on organizational culture has been performed in neonatal patient populations.

Method: This combined cross-sectional survey and retrospective cohort study assessed employee perceptions of organizational culture and QI implementation within 18 Canadian neonatal intensive care units.

The Evidence-based Practice for Improving Quality method has greater impact on improvement of outcomes than dissemination of practice change guidelines and quality improvement training in neonatal intensive care units.

Objectives: To determine whether outcome improvements achieved by neonatal intensive care units (NICUs) in the Evidence-based Practice for Improving Quality (EPIQ) trial could be reproduced in other NICUs by providing quality improvement (QI) training and practice change guidelines developed during the EPIQ trial; and to examine whether the results of the EPIQ trial were sustained.

Methods: The present prospective before-after study included 5812 infants born at ≤32 weeks' gestation and admitted to 19 level 3 NICUs in the Canadian Neonatal Network between October 1, 2005 and December 31, 2007. During a three-month baseline period, multi-disciplinary teams received general training in QI techniques at a two-day workshop, and practice change guidelines targeting nosocomial infection (NI) and bronchopulmonary dysplasia (BPD) developed during the EPIQ trial were provided to all participants.

Variations in transport outcomes of outborn infants among Canadian neonatal intensive care units.

Background: Outborn infants born at community hospitals and transported to tertiary neonatal intensive care units (NICUs) for treatment account for 20% of all tertiary NICU admissions in Canada. Little is known about variations in their outcomes. The Transport Risk Index of Physiologic Stability (TRIPS) is a validated score of neonatal physiological status that can identify differences between transport teams' outcomes.

Adverse events among children in Canadian hospitals: the Canadian Paediatric Adverse Events Study.

Background: Limited data are available on adverse events among children admitted to hospital. The Canadian Paediatric Adverse Events Study was done to describe the epidemiology of adverse events among children in hospital in Canada.

Methods: We performed a 2-stage medical record review at 8 academic pediatric centres and 14 community hospitals in Canada.

Reflections on knowledge translation in Canadian NICUs using the EPIQ method.

The Canadian Neonatal Network conducted a trial of Evidence-Based Practice for Improving Quality (EPIQ) between 2002 and 2005. Improved neonatal intensive care unit (NICU) outcomes established credibility for quality improvement. We surveyed team members and physician leaders to examine critical success factors and barriers to improvement during EPIQ.

Normal adrenal function in an infant following a pregnancy complicated by maternal adrenal cortical carcinoma and mitotane exposure.

Maternal adrenal cortical carcinoma in pregnancy is rare. We report a case of an infant born to a mother with a history of adrenal cortical carcinoma. The pregnancy was complicated by fetal exposure to mitotane and dexamethasone.

Description of the development and validation of the Canadian Paediatric Trigger Tool.

Objective: To describe the process of developing and validating the Canadian Association of Paediatric Health Centres Trigger Tool (CPTT).

Methods: Five existing trigger tools were consolidated with duplicate triggers eliminated. After a risk analysis and modified Delphi process, the tool was reduced from 94 to 47 triggers.

Improving the quality of care for infants: a cluster randomized controlled trial.

Background: We developed and tested a new method, called the Evidence-based Practice for Improving Quality method, for continuous quality improvement.

Methods: We used cluster randomization to assign 6 neonatal intensive care units (ICUs) to reduce nosocomial infection (infection group) and 6 ICUs to reduce bronchopulmonary dysplasia (pulmonary group). We included all infants born at 32 or fewer weeks gestation.

Five years of learning from analysis of clinical occurrences in pediatric care using the London Protocol.

A Protocol for the Investigation of Clinical Incidents (1999) was piloted on a Winnipeg high-risk neonatal service in 2001, and was subsequently adopted as the investigative tool of choice at the Winnipeg Regional Health Authority (WRHA). The paper describes the pilot and subsequent experience with the updated London Protocol (2004) in the WRHA Child Health Program. Themes include: tightly coupled systems; multiplicity of contributory factors; medication safety; predominance of "near misses"; authority gradient; professional accountability; partnerships; and implementation challenges.

Actuarial survival of a large Canadian cohort of preterm infants.

Background: The increased survival of preterm and very low birth weight infants in recent years has been well documented but continued surveillance is required in order to monitor the effects of new therapeutic interventions. Gestation and birth weight specific survival rates most accurately reflect the outcome of perinatal care. Our aims were to determine survival to discharge for a large Canadian cohort of preterm infants admitted to the neonatal intensive care unit (NICU), and to examine the effect of gender on survival and the effect of increasing postnatal age on predicted survival.