NEW ORLEANS, LA -Yale-New Haven Children's Hospital was selected as the overall winner of the 2015 Pediatric Quality Award for a quality improvement project that reduced the number of days infants with neonatal abstinence syndrome (NAS) were hospitalized. Since 2011, the effort of bundled interventions has resulted in $5.4 million in total savings due to a reduction in patients' average length of stay and a reduction in morphine treatment, a pharmacological protocol for NAS patients. The award was presented at the Quality and Safety in Children's Health Conference held in New Orleans, LA, this week.
"As leaders in quality improvement, children's hospitals are continually innovating new standards of care across multiple patient populations, from the sickest infants to well children, with the goal of better health outcomes," said Amy Wimpey Knight, chief operating officer, Children's Hospital Association (CHA). "Yale-New Haven Children's Hospital focused on improving care for babies born with opiates dependencies, a growing problem in our country. We are very proud to honor this important initiative with the Pediatric Quality Award."
By increasing the practice of non-pharmacological care such as low-stimulation rooms, swaddling, soothing, feeding on demand and rocking to enhance the bond between mother and child, the hospital worked with families to decrease average length of stay from 28 days (measured from 2003-2006) to 8.5 days (re-measured in 2014-2015) for patients in its neonatal intensive care unit (NICU) and 6.5 days for patients transferred from the nursery directly into the general inpatient unit (without a NICU stay). Morphine treatment in the NICU was decreased from 98 percent to 44 percent, and the maximum dose administered to this population was reduced by over 50 percent.
In the last 15 years, NAS, a condition where newborns exposed to addictive opiates while in utero display withdrawal symptoms impacting their neurological, gastrointestinal and musculoskeletal systems, has increased five-fold. The rise of NAS nationally has led to a steady increase in length of stay across hospital NICUs, costing the U.S. health care system as much as $1 billion per year.
"The staff at Yale-New Haven demonstrated innovative and important work in its identification of non-medical intervention in delivering quality improvement," said Helen Burstin, MD, MPH, FACP, chief scientific officer of The National Quality Forum who served as an industry judge for the award. "The study was elegantly designed and yielded impressive results leading to meaningful engagement with patients."
Awarded biennially by CHA, the Pediatric Quality Award honors successful quality improvement initiatives that significantly improve care for pediatric patients. The overall winner was selected from 76 entries by a panel of more than 40 quality improvement and patient safety leaders from children's hospitals as well as two industry experts in addition to Burstin: Peter Lachman, MD, MPH, MBBCH, FCP deputy medical director, Great Ormond Street Hospital for Children NHS Trust; and Virginia Moyer, MD, MPH vice president for maintenance of certification and quality, the American Board of Pediatrics.
In addition to being named the overall winner for is initiative titled Sustained Reduction in Length of Stay for Neonates with Neonatal Abstinence Syndrome, Yale-New Haven Children's Hospital was the winner in the clinical care category.
Three other children's hospitals were named category winners, and one was recognized with a distinctive achievement award, for their improvement initiatives:
Delivery System Transformation Category Winner: Levine Children's Hospital at Carolinas HealthCare System, Charlotte, NC Developing Future Improvement Leaders: Experiential QI Training in Residency
Patient Safety and Reduction of Harm Category Winner: Doernbecher Children's Hospital at OHSU, Portland, OR Reducing Radiation Exposure: Pediatric Modified Barium Swallow Studies
Waste Reduction and Improved Efficiency Category Winner: Children's of Alabama, Birmingham, AL Decreasing Hospital Length of Stay for Post-operative Adolescent Spinal Fusion Patients
Distinctive Achievement Award, Clinical Care: Cincinnati Children's Hospital Medical Center, Cincinnati, OH Using Quality Improvement to Reduce Necrotizing Enterocolitis across Hospital Systems
For video footage of winning projects visit Children's Hospital Association.