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Results

Antibiotic Stewardship

June 2016 to November 2017

Our Antibiotic Stewardship Collaborative included 28 of our member NICUs, the largest group to date, and aimed to reduce antibiotic utilization rates through the application of a bundle of best practices, including routine antibiotic “time-outs” 48-72 hours after obtaining cultures. While a thorough analysis of the data is still underway, preliminary findings indicate that the collaborative group eliminated roughly 11,700 “antibiotic days” across California and safely decreased the antibiotic utilization rate (AUR) by 13.8%. These improvements helped to decrease the risk of antibiotic resistance andadverse drug events as well as the cost of care at these NICUs.


Optimizing Length of Separation

June 2013 to May 2015

20 of our member NICUs participated in the Optimizing Length of Separation Collaborative, which aimed to reduce length of hospital stay by three days for infants born between 27-32 weeks gestational age. Participants were encouraged to use a standardized approach to feeding, discharge planning, and apnea/bradycardia management in order to achieve this aim. By the end of the 18-month collaborative, participants decreased length of separation by three days and increased early discharge (before 36 weeks, 5 days) to 41.9% from 31.6%. 

Related Publication: Comparison of Collaborative Versus Single-Site Improvement to Reduce NICU Length of Stay


Delivery Room Management  

 June 2011 to November 2012

The 20 hospitals in the Delivery Room Management Collaborative saw a collective decrease in hypothermia, delivery room intubation, and surfactant administration as a result of their participation. The project aimed to improve management of high-risk deliveries through implementation of a best practice bundle that included strategies to avoid hypothermia; establish lung volume in the least-invasive manner; and support teamwork with checklists, briefings, and debriefings. 

Related publication: Implementation methods for delivery room management: a quality improvement comparison study


Breastmilk Nutrition 

September 2009 to April 2011

11 CPQCC NICUs participated in a collaborative designed to increase breastmilk feeding rates for VLBW infants through implementation of a set of best practices outlined in the CPQCC Nutritional Support of the VLBW Infant Toolkit. The toolkit was subsequently updated in 2018. By the end of the collaborative, participants had increased breastmilk feeding at discharge to 64%, from 54.6% at the start of the collaborative. Participants also saw a decrease in NEC rates from 7% to 2.4%.

Related publication:  Perspectives on Promoting Breastmilk Feedings for Premature Infants During a Quality Improvement Project


Healthcare-Associated Infections

February 2008 to January 2009

The 19 NICUs in the Healthcare Associated Infections Collaborative decreased catheter-associated bloodstream infections (CABSIs) by 75% in infants with birth weights ≤ 1500 grams. The project aimed to reduce the occurrence of CABSI to almost zero system-wide.