Measuring practice preference variation for quality improvement in neonatal respiratory care

Helen Healy; Emily Whitesel; Wenyang Mao; Colby L Day; Thomas G Murphy; Clara H Song; Patricia K Williams; Sandhya S Brachio; Parul Cham; Rebecca J Vartanian; Steven Chin; Puneet Arora; Matthew Bizzarro; David W Sink; John A F Zupancic; Munish Gupta

doi:10.1038/s41372-024-01956-w

Measuring practice preference variation for quality improvement in neonatal respiratory care

J Perinatol. 2024 Apr 8. doi: 10.1038/s41372-024-01956-w. Online ahead of print.

Authors

Affiliations

¹ Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. hhealy@bidmc.harvard.edu.
² Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
³ University of Florida Jacksonville/Wolfson Children's Hospital, Jacksonville, FL, USA.
⁴ Goryeb Children's Hospital, Morristown, NJ, USA.
⁵ University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
⁶ Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, Manhattan, NY, USA.
⁷ Michigan Medicine, Ann Arbor, MI, USA.
⁸ Children's Hospital Los Angeles, Los Angeles, CA, USA.
⁹ Yale New Haven Children's Hospital, New Haven, CT, USA.
¹⁰ Connecticut Children's, Hartford, CT, USA.

PMID: 38589537
DOI: 10.1038/s41372-024-01956-w

Abstract

Objectives: The authors sought to measure and compare practice preference variation in neonatal respiratory care within and between neonatal intensive care units (NICUs) using the Neonatology Survey of Interdisciplinary Groups in Healthcare Tool (NSIGHT).

Study design: Eleven NICUs completed the NSIGHT between 2019 and 2021. Net preference was measured by mean response; agreement was ranked by standard distribution of response values. Heat maps showed comparisons between NICUs and disciplines.

Results: NICUs and individuals agreed most often on use of pressure support with mandatory ventilation and on use of non-invasive positive pressure ventilation for apnea. High preference variation surrounded decisions for invasive ventilation versus continuous positive airway pressure for extremely low birth weight infants. Preference difference was most frequent between neonatologists and nurses.

Conclusions: Patterns of practice preference variation in neonatal respiratory care are specific to clinical scenario. Measuring preference variation may inform psychology of change and strengthen quality improvement efforts.