2010 Award Finalist

Evidence-based Practice to Improve Quality (EPIQ) in the neonatal ICU

Category - Improving Evidence-Based Practice

The Problem

Maternal and infant health are key indicators of a nation's health and well being. Although the rates of infant mortality and morbidity in preterm infants are declining in Canada, the decrease is not as large in this country as elsewhere and worldwide we have slipped from 8th to 23rd place. In addition, estimates of the costs associated with preterm birth exceed $1 billion annually in Canada. Although attempts have been made to improve care in neonatal intensive care units (NICUs), there has been significant variation in outcomes between different units. This is partly due to practice differences, along with the fact that improvements being implemented in NICUs are based on intuition and anecdote instead of best evidence. There is therefore a strong need for a scientific method of quality improvement that can both identify and quantify beneficial practice changes.

The Innovation

The Canadian Neonatal Network has developed the Evidence-based Practice for Improving Quality (EPIQ) method. This method provides site investigators with a quantified assessment of outcomes at their unit. A collaborative network of investigators from all the different sites then objectively assess the evidence supporting all the different practice changes that might potentially improve those outcomes, and develop site-specific strategies for changes in practice that need to be made. The EPIQ initiative was initiated in 2002, and for Phase 1 it underwent a 1-year baseline and development process, followed by a 2-year implementation phase, which was completed in 2005. Phase 2 was initiated in 2008. The development and baseline process was completed in early 2010, and the implementation phase will be completed in 2011. The EPIQ method is now being used to reduce the incidence of infections and respiratory problems in 12 NICUs across Canada.

The Results

When practice changes aimed at reducing the incidence of health care-associated infection in preterm infants were introduced, there was a 35 percent reduction in that incidence. When practice changes directed at bronchopulmonary dysplasia (a chronic lung condition that affects newborn babies who were either put on a breathing machine after birth or were born prematurely) were implemented, there was a 15 percent decrease in the incidence. In addition to the quantitative data collection, the Canadian Neonatal Network conducted interviews of neonatal intensive care staff to give qualitative feedback on hospital-specific organizational issues, barriers to change, and potential change strategies. An important additional affect of these interviews was that they increased staff awareness, and enhanced staff "buy-in", which facilitated practice change.

Next Steps

The Canadian Neonatal Network is expanding the project to target five of the major morbidities that affect preterm infants in NICUs, and increased the number of sites involved to now include almost all of the 30 neonatal intensive cares across Canada. The EPIQ method is also being expanded to incorporate international best practices. These new practices will initially be implemented in a subgroup of the Canadian NICUs, then, will be extended to all the units across Canada.