141 - From Pathway to Practice: Implementing Evidence-Based Quality Improvement for ELBW Care

Publication Number: 3135.141

Susan M. Bedwell, Oklahoma Children's Hospital at OU Health Campus, Guthrie, OK, United States; Ulana Pogribna, Oklahoma Childrens Hospital at OU Health, Oklahoma City, OK, United States

Background: Structured clinical guidelines and pathways improve outcomes in neonatal care. At Oklahoma Children's Hospital, the need for a standardized approach to extremely low birth weight (ELBW) infants became urgent due to rising acuity and care variability.

Objective: Despite existing nursing protocols, the unit lacked comprehensive interdisciplinary pathways for ELBW infants. By the end of 2024, we aimed to develop (Phase 1) and implement (Phase 2) comprehensive care pathways for ELBW infants to reduce intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP) by 10% compared to baseline.

Design/Methods: An evidence-based practice (EBP) quality improvement (QI) framework was utilized to guide all phases of the initiative. In phase 1, multidisciplinary teams developed eight clinical pathways using evidence-based models. The Appreciative Inquiry framework was used to engage staff and build consensus. The interdisciplinary workgroups conducted literature reviews, developed system-based pathways, and facilitated iterative revisions. Following implementation, the Institute for Healthcare Improvement (IHI) Model for Improvement was employed to develop and guide Plan-Do-Study-Act (PDSA) cycles for Phase 2. To support the implementation of standardized clinical pathways, a multifaceted strategy was employed, emphasizing education, hands-on exposure, and consistent reinforcement through saturation. Real-time data collection guided iterative improvements over six PDSA cycles. Each PDSA cycle focused on optimizing key aspects of neonatal care, including thermoregulation, line placement, timely surfactant administration, and glucose and oxygen management. Interventions were delivered through peer-to-peer teaching, targeted skills labs, multidisciplinary town halls, staff meetings, and regular email communications.

Results: A total of 245 infants were included. Post-implementation data (n=130) showed a reduction in severe IVH (from 25% to ~20%), a decrease in grades 2 and 3 BPD rates (not statistically significant), consistently low ROP rates ( < 3%), and a downward mortality trend in 2023.

Conclusion(s): The development and implementation of comprehensive, interdisciplinary care pathways for ELBW infants led to measurable improvements in key clinical outcomes. This initiative demonstrates the effectiveness of a structured, collaborative approach grounded in evidence-based practice and continuous quality improvement. Ongoing refinement and data monitoring will support further reductions in morbidity and advance the standard of care for this high-risk population.

Severe Intraventricular Hemorrhage (Grade 3 and 4)
The numbered arrows represent the PDSA cycles.

BPD Severity
The numbered arrows represent PDSA cycles.

Severe Retinopathy of Prematurity
The numbered arrows represent PDSA cycles.