155 - Impact of a Hospital-Wide Safe Sleep Education Quality Improvement Project on SUID Rates Using Linked Child Fatality Review Data

Publication Number: 3149.155

Kirsten Bechtel, Yale School of Medicine, New Haven, CT, United States; Marin Karsmarski, Yale-New Haven Children's Hospital, New Haven, CT, United States; Lauren Carroll, Yale New Haven Hospital, Guilford, CT, United States; Alison Maturo, Yale-New Haven Children's Hospital, New Haven, CT, United States; Gunjan Tiyyagura, Yale School of Medicine, New Haven, CT, United States

Background: Sudden unexplained infant death (SUID) is a leading cause of post-neonatal mortality. Frequently, these infants are found in unsafe sleep environments that do not conform to the American Academy of Pediatrics' recommendations (i.e., sleeping alone, on their back, on an approved sleep surface that is not cluttered with blankets, pillows, toys, or other items). We sought to determine if a hospital-based quality improvement project to promote safe infant sleep among caregivers of infants using linked outcome data from child fatality review would lead to a reduction in the proportion of SUID due to unsafe sleep in infants born at our hospital.

Objective: We aimed to increase the interval of days between SUID cases among infants born at the largest birthing hospital in Connecticut.

Design/Methods: Guided by the model for improvement, we formed a hospital-wide team of multidisciplinary stakeholders, including nurses, physicians, social workers, hospital administrators, and caregivers. We reviewed the meeting minutes of a statewide child fatality review to identify key drivers of safe sleep practices. We then conducted Plan-Do-Study-Act cycles to test and refine interventions, including the development of educational materials, training for new caregivers and community pediatricians, and a safe sleep action plan for all caregivers with an infant (Figure 1). We used linked data from the State of Connecticut Child Fatality Review as surveillance of the SUID rate among infants born at our hospital. Given the rarity of SUID cases, the primary outcomes were the number of days between SUID cases due to unsafe sleep and the proportion of infants born at our hospital who died of SUID each year.

Results: Evidence of special cause variation was observed in the t-chart, starting in May 2020, with the number of days between cases of SUID due to unsafe sleep increasing from 31 days to 129 days (Figure 1). The SUID rate due to unsafe sleep declined from 1.4% of births in 2019 to 0.02% of births in 2025 (Fisher's exact X2 = 4.04; p < .05). During this period, the overall birthing rate and infant demographics at our hospital did not change significantly. To date, it has been 420 days since the last SUID case of an infant born at our hospital.

Conclusion(s): A hospital-wide quality improvement initiative to provide comprehensive, safe infant sleep guidance to caregivers of infants using linked child fatality review data has the potential to reduce the rate of SUID due to unsafe sleep in infants born at a hospital.

Figure 1
Process Control T-chart of the number of days between cases of SUID due to unsafe sleep