District 8 Quality Improvement and Outcomes Committee





The District VIII QI and Outcomes Committee presents:
Quality Improvement Clinic - The Doctor is in!
Saturday May 31st, 2014
As part of the
38th Annual Conference
AAP District VIII Section on Perinatal Medicine
Denver City Center Marriott
Denver, Colorado
May 29 - June 1, 2014

Session Agenda

1300-1305p             Welcome Remarks                 

                                Lily Lou, MD                            Session Moderator


1305-1320p             Evaluation of sepsis in the NBICU:  Work-up and antibiotic administration - Can we do better? – An Update

                                Jessie Maxwell MD and Ann Winegardner, MD                      Albuquerque, NM

                                University of New Mexico

                                jrmaxwell@salud.unm.edu and awinegardner@salud.unm.edu


This is a follow up from last year’s QI workshop session presentation.  In this fellow driven project, sepsis evaluation practices after the first 3 days in the NBICU was examined- labs ordered, antibiotic choice and duration, culture results, etc.  Study aim was to identify variations in practice and devise strategies to standardize care.


1320-1335p             Antibiotic stewardship in the NICU                 

                                Lynnette Johnson, MD                                                             Honolulu, HI

                                University of Hawaii, Kapiolani Medical Center



This is the first phase of an antibiotic stewardship project aimed at decreasing unnecessary/excess antibiotic administration in the NICU.


1335-1350p          An intubation audit to decrease BPD                      

                                Emmanuel Ramirez-Enriquez, MD                                           Honolulu, HI

                                University of Hawaii, Kapiolani Medical Center



Accidental extubation with subsequent reintubation has been suggested as one potential mechanism contributing to the development of BPD.  We sought to determine whether or not accidental extubation is a common problem in our NICU and whether or not practice change is warranted.


1350-1410p             Improving newborn care through improved compliance with NRP

                                Adele Harrison, MD                                                                 Victoria, BC

                                Victoria General Hospital



The effective resuscitation of a newborn involves the interaction of individuals with the appropriate knowledge and skills working in an interdisciplinary team and utilizing specific equipment in a high stress setting. This project addresses the gap between attendance at an NRP course on a 2 yearly cycle and the practical application of NRP in the clinical setting.


14010-1435p           Potentially better practices schema to improve outcomes in VLBW infants – The Antifragility Project

                                Joseph Kaempf, MD                                                                Portland, OR

                                Providence St. Vincent Medical Center



                                MDs and NNPs combed the literature for commonly used therapies related to the 9 major outcomes seen in VLBW infants (CLD, PDA, SROP, SIVH, PVL, NEC, GIP, D/C Wt < 10th %ile, and any late infection) to produce a concise 2 page document that summarizes complex topics with the goals of a) providing clarity to NICU staff who find it difficult to keep track of various Rx’s and PBPs, b) remind MDs and NNPs to employ evidence-based practices and treatments and c) update yearly as new RCTs and evidence are published.


1435-1455p             Implementation of evidence-based nutritional practices in VLBW infants decreases the rate of extra-uterine growth restriction

        Alfonso Pantoja, MD and Ann Lewis RD                  Denver, CO

                                Exempla St. Joseph’s Hospital

                                Alfonso.Pantoja@sclhs.net and Ann.Lewis@sclhs.net


                                Starting in March 2005, a “bundle” of five potential better practices were implemented using PDSA cycles by a multidisciplinary team. Implementation of evidence-based nutritional practices resulted in a significant improvement in growth parameters of VLBW infants and the frequency of extra-uterine growth restriction at discharge.


1455-1505p             Break


1505-1525p             A better path home, under construction

                                James S Barry, MD and Kirtley Ceballos, RN                        Denver, CO

                                University of Colorado

                                james.barry@ucdenver.edu and Kirtley.Ceballos@uchealth.org


Some families are not always prepared to take their child(ren) home on the day of discharge. Project Aim: To optimize parent education, assess parent readiness for discharge, and reduce preventable harm to high-risk infants after discharge. Methods: From May-Dec 2013, discharge process was evaluated using process mapping, staff/parent surveys, stakeholder and waste analysis.  From these analyses several interventions were developed.


1525-1545p             Failure of outpatient first dosing regime of Synagis during RSV season

                                Carl Bodenstein, MD                                                               Spokane, WA

                                Providence Sacred Heart Children's Hospital



                                To cut inpatient pharmacy costs during the 2012 - 2013 RSV season, a pilot project was created to        provide the initial dose of Synagis within 48 hours of discharge from the NICU.  Pre-approval and all insurance clearance was started on admission of the at risk patient.


1545-1605p             Prototype process standardization.  Kangaroo care on respiratory support

                                Lily Lou, MD                                                                            Anchorage, AK

                                Providence Alaska Medical Center



Kangaroo care on respiratory support was the prototype project for unit-wide efforts to educate and utilize a process standardization strategy.


1605-1625p             Results of the Colorado Perinatal Quality Improvement Collaborative.

        Alfonso Pantoja, MD                                                                Denver, CO

                                Exempla St. Joseph’s Hospital



As the Coordinator of Collaborative Work of the CPCC, Dr Pantoja will share their work to: decrease elective deliveries before 39 weeks, reduce  blood stream infections, increase the use of antenatal steroids, and improve breast milk feeds in VLBW infants at discharge


1625-1645p             Utilizing a collaborative model to determine best practices and improve neonatal outcomes: the Children's Hospitals Neonatal Consortium experience

                                Theresa Grover, MD                                                               Denver, CO

                                Children’s Hospital Colorado



This is not your traditional QI project. The Children's Hospitals Neonatal Consortium (CHNC) consists of 29 Children's Hospital NICUs that contribute to a common clinical database and support several focus groups to analyze the data related to specific diagnoses. This presentation will share how a large collaborative group and database can develop relevant benchmarking, determine practice variation, correlate that with outcomes, and work together to improve care.



1645-1700p             Roundtable discussion/Q & A session

                        2015 Workshop planning

Closing remarks/Adjournment





 Committee Purpose:   To improve healthcare and outcomes for neonates within the district through multicenter collaboration

Chair: Sheree Kuo (2012)


By State/Province Vacancies
Lily Lou (Alaska) (Alberta)
Mark Hudak (Florida) (Nevada)
Sheree Kuo (Hawaii) (Montana) 
Amy Kirk (Idaho) (New Mexico) 
James Barry (Colorado) (Oregon) 
Robert DiGeronimo (Utah) (Uniformed Services) 
Ravi Krishnan (California)


Carlos Flores (Arizona)  (Wyoming)
Adele Harrison (British Columbia) 


 Aims and Goals

  1. Create a forum for neonatal practitioners to share QI experiences with a collegial atmosphere for learning and collaboration
  2. Connect practitioners with various levels of expertise and experiences with QI so that we can all learn from each other

Getting Started

For more information regarding the District VIII Quality Improvement and Outcomes Committee, please contact


Sheree Kuo

Committee Chair & CNN/INC US Sites Coordinator

Priscilla Chan CNN/INC Coordinator pchan2@mtsinai.on.ca
Vinthiya Param  EPIQ Coordinator vparam@mtsinai.on.ca 

Or learn more on the web at:



If we walk together, a path emerges - Indian Proverb