119 - Implementation of a Multicenter EHR Rounding Checklist Tool Supporting Neonatal Quality Improvement and Safety

Publication Number: 3113.119

Alex B. Ruan, Children's Hospital of Philadelphia, Drexel Hill, PA, United States; Osvaldo Mercado, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Deborah Welsh, Penn Medicine, Media, PA, United States; Matthew Devine, Childrens Hospital of Philadelphia, Collingswood, NJ, United States; Bolu Oluwalade, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Lisa Drinker, Childrens Hospital of Philadelphia, West Chester, PA, United States; Thomas Habib, Childrens Hospital of Philadelphia, Princeton, NJ, United States; Marilyn Giorgi, CHOP Newborn Care Network Penn Medicine Princeton, East Brunswick, NJ, United States; Samuel Garber, Perelman School of Medicine at the University of Pennsylvania, Voorhees, NJ, United States; Hannah Postiglione, Childrens Hospital of Philadelphia, Cherry Hill, NJ, United States; Matthew Coyle, Childrens Hospital of Philadelphia, Springfield, PA, United States; Lori Christ, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Leah Carr, Childrens Hospital of Philadelphia, Philadelphia, PA, United States

Background: In 2019, a NICU in our health system implemented a REDCap-based checklist to support local quality improvement (QI) and safety initiatives, but tool compliance was less than 50%. A 2023 provider survey revealed low perceived relevance and high burden, with key barriers including workflow interruptions and tool accessibility. Feedback strongly supported electronic health record (EHR) integration. Given four NICUs share the same EHR instance, there was enterprise-wide support for developing a standardized solution for broader implementation.

Objective: To implement a standardized, EHR-integrated clinical decision support (CDS) rounding checklist tool across four NICUs and assess usability and clinical relevance. Our team sought to increase compliance from 42% in 2023-2024 to over 85% by October 2025 at the initial pilot NICU.

Design/Methods: A multidisciplinary team collaborated to design the tool. Site-specific workflow analyses were conducted to ensure local usability. The CDS was embedded within the EHR, using rule-based logic to display patient- and unit-relevant questions. The tool is accessible via mechanisms aligned with typical workflows, with visual indicators for checklist completeness (Figure 1). Discrete data capture enables dashboard creation for operational review.

Process measures included compliance and provider-reported usability and relevance; balancing measures included perceived burden and workflow impact.

Results: Statistical process control p-chart for biweekly compliance with the tool at the initial pilot NICU from October 2023 to October 2025 showed an increase in the center line to 90% (Figure 2). After expansion to all four NICUs in March 2025, compliance was 86% as of October 2025. Survey data (67% response rate, 66/98) indicated that most NICU clinicians found the tool easy to use, clinically relevant, and beneficial for patient safety (Figure 3). 77% (51/66) rated the tool as somewhat or completely relevant to patient care, while only 5% (3/66) found it very burdensome. Specific QI/safety initiatives supported to date include kangaroo care, central line position surveillance, and follow-up clinic candidate identification, among others.

Conclusion(s): To our knowledge, this is the first multi-NICU implementation of such a CDS checklist tool. The tool has been well received by providers, with high reported usability and clinical relevance, and improved compliance. Importantly, the tool supports both system-wide standardization and unit-specific initiatives. Further work using quasi-experimental methodology to assess the impact of the tool on clinical outcomes is underway.

Figure 1
Left: Screenshot of the CDS rounding checklist tool as it appears in the EHR for a test patient. Right: Visual indicator on the patient list showing tool completion status.

Figure 2
P-chart showing biweekly compliance (process measure) with the REDCap rounding checklist tool and subsequently the EHR CDS rounding checklist tool in the initial pilot NICU. Plan-Do-Study-Act (PDSA) cycles shown on P-chart. This P-chart illustrates an initial unstable process that became more controlled following implementation of the EHR CDS tool. The center line (mean) increased from 25% in the immediate pre-EHR phase to 90% after EHR CDS tool implementation. *Special cause variation is noted in December 2023-January 2024, coinciding with the holiday period, as well as June 2025, coinciding with high unit acuity and census, as well as resident turnover.

Figure 3
Results of a survey distributed to NICU providers from all four NICUs approximately two months following EHR integration. The survey had a 67% response rate (66 of 98 providers).