082 - Collaborative, Consistent Care: How A Multidisciplinary Team for Bronchopulmonary Dysplasia Reduced Discharge Home with Oxygen

Publication Number: 82.4103

Kathryn Berlin, Medical College of Wisconsin, Elm Grove, WI, United States; Margaret E. Malnory, Medical College of Wisconsin, Wauwatosa, WI, United States; Elizabeth Orloski, Childrens Wisconsin, Wauwatosa, WI, United States; Ashley Zambo, Children's Hospital of Wisconsin, Milwaukee, WI, United States; Sara Dawson, Medical College of Wisconsin, Milwaukee, WI, United States; Joanne Lagatta, Medical College of Wisconsin, Milwaukee, WI, United States

Background: Bronchopulmonary dysplasia (BPD) is the most common morbidity of prematurity and is associated with the prolonged need for respiratory support and an extended length of stay. Four years ago, our Level IV NICU at a Midwest academic center began working to improve the discharge process for patients with BPD requiring home oxygen by improving parental education. This process led to the recognition that a BPD-specific service would benefit this population.

Objective: To establish a specific primary service for infants with Grade II to III BPD and study the effects on discharge home with respiratory support.

Design/Methods: The initial effort was launched in April of 2021 at a 70-bed level IV NICU with an average daily census of 10-18 patients with Grade II to III BPD per the 2019 NRN criteria. During our PDSA cycles, we created a key driver diagram summarizing our improvement theory of factors associated with improved outcomes in BPD (Figure 1). We determined that consistency of care was critical to improving our outcomes in BPD and began planning our service in late 2021. This service launched in October 2023: patients with Grade II to III BPD were transferred to this team (staffed by a multidisciplinary team comprising neonatology providers, a dedicated care coordinator (PNP), pulmonary providers, nurses, respiratory therapists, physical and occupational therapists, speech therapists, registered dietitians, and pharmacists) when around 36 weeks post-menstrual age. Core BPD providers engage in standard bedside rounds daily, with an additional team meeting on Tuesdays and multidisciplinary rounds on Thursdays to allow for consistent care. As this was a quality improvement effort, we tracked several quality measures, including discharge respiratory support, length of stay after 36 weeks, and adherence to team protocols, including pulmonary hypertension screening.

Results: Since its launch in October 2023, this team has cared for 64 patients with a median weekly census of 14. We evaluated changes in discharge home on respiratory support with statistical process control (Figure 2). Ultimately, we noted a slight shift (79% to 70%) that occurred around the time of the initial parental education project, while a significant shift (70% to 47%) occurred after the start of our staffing model. This was without an increase in length of stay (Figure 3).

Conclusion(s): Consistent care provided by a dedicated multidisciplinary team can reduce the need for respiratory support at discharge in patients with Grade II-III BPD.

Figure 1: Key Driver Diagram
Figure 1.pdfOur team assembled a key driver diagram to inform our quality improvement effort. Ultimately, we determined that consistent care, efforts toward improved growth, and optimization of care after the NICU were major drivers of improved outcomes in BPD. Our quality improvement efforts were thereby directed towards these goals.

Figure 2: Discharge on Respiratory Support
Figure 2.pdfThe above p chart depicts the percentage of patients discharged home on any respiratory support (home oxygen therapy or tracheostomy) over time. A small shift occurred around March 2022, not long after a program designed to improve parental education regarding home oxygen therapy weaning was launched. The largest shift occurs in January 2024, a few months after the initiation of our BPD primary service.

Figure 3: Length of Stay After 36 Weeks PMA
Figure 3.pdfFigure 3 is an X-bar-S chart demonstrating the length of stay of infants with BPD after 36 weeks PMA. The figure shows no increased length of stay associated with initiation of this BPD-specific service.

Figure 1: Key Driver Diagram
Figure 1.pdfOur team assembled a key driver diagram to inform our quality improvement effort. Ultimately, we determined that consistent care, efforts toward improved growth, and optimization of care after the NICU were major drivers of improved outcomes in BPD. Our quality improvement efforts were thereby directed towards these goals.

Figure 2: Discharge on Respiratory Support
Figure 2.pdfThe above p chart depicts the percentage of patients discharged home on any respiratory support (home oxygen therapy or tracheostomy) over time. A small shift occurred around March 2022, not long after a program designed to improve parental education regarding home oxygen therapy weaning was launched. The largest shift occurs in January 2024, a few months after the initiation of our BPD primary service.

Figure 3: Length of Stay After 36 Weeks PMA
Figure 3.pdfFigure 3 is an X-bar-S chart demonstrating the length of stay of infants with BPD after 36 weeks PMA. The figure shows no increased length of stay associated with initiation of this BPD-specific service.