HAP Achievement Awards Spotlight: St. Luke’s University Health Network
December 05, 2018
This week, HAP is spotlighting St. Luke’s University Health Network’s work to provide excellent care to Pennsylvania’s smallest patients.
St. Luke’s University Health Network received HAP’s 2018 “Excellence in Care” Achievement Award for its successful program to reduce the rates of pneumothoraces (collapsed lungs) in its high-risk infants. As a result of its initiative, “Don’t Just Do Something—STAND THERE—Reducing Incidence of Pneumothoraces in High Risk Newborns,” St. Luke’s successfully improved its pneumothorax rate to a top-quartile performance target of 1.7 percent.
The team at St. Luke’s reviewed its outcomes and found that its rate of neonatal pneumothorax was below the average for outcomes in this area. The team’s previous efforts to improve this metric had only marginal success.
A review of current practices showed opportunities for more staff education about potentially better practices to mitigate newborn lung damage. The team studied key contributors to neonatal pneumothorax and best practices for after-birth intervention. A team of staff worked to find potential gaps in care for high-risk infants. Using a “Plan, Do, Check, Act” improvement methodology, the team identified and put in place four cycles of interventions:
- Purchase and utilize three volume-targeted ventilators
- Implement new extubation criteria using lung-proactive strategies
- Utilize animal-derived lung surfactants for infants under 1500 grams
- Expand use of animal-derived lung surfactants for all infants. This change was implemented following a conference and collaborative discussions with other hospital staff regarding best practices for lung interventions
The team tracked outcome rates and the group achieved its target outcomes during the second quarter of 2017, and maintained them throughout the third-quarter tracking window. Through these collaborative efforts, it reduced the rate of pneumothorax by 69 percent—from 5.2 percent at its highest to 1.7 percent. The team credits a culture of collaboration and the full support of hospital administration for this success. They will continue to track this metric and increase education about potentially better practices, and will expand upon this project during the future.
The project name derives from the team’s reflection upon the White Rabbit from Alice in Wonderland. The team mused that, in cases of care for high-risk newborns, it often is better to slow down and observe the patient, rather than—as the rabbit does—run around in constant motion. In taking the time to carefully consider the patient's unique needs, the team learned vital lessons that helped it create a plan of action that improved pneumothorax outcomes and lowered the length of stay for newborns.
This project can be replicated in facilities that have an in-house neonatal team available around the clock.
Congratulations to St. Luke’s University Health Network for improving outcomes for its high-risk newborn population and for its receipt of a 2018 HAP Achievement Award. Learn more about this effort as well as the other 2018 award-winning programs at HAP’s website.
Questions about the HAP Achievement Awards may be directed to HAP Member Services at (717) 561-5359.