• Shoo K Lee, Khalid Aziz, Nalini Singhal, Catherine M Cronin, Andrew James, David S C Lee, Derek Matthew, Arne Ohlsson, Koravangattu Sankaran, Mary Seshia, Anne Synnes, Robin Walker, Robin Whyte, Joanne Langley, Ying C MacNab, Bonnie Stevens, and Peter von Dadelszen.
• Departments of Paediatrics, University of Toronto, Toronto, Ontario, Canada. sklee@mtsinai.on.ca
• CMAJ. 2009 Oct 13; 181 (8): 469476469-76.

BackgroundWe developed and tested a new method, called the Evidence-based Practice for Improving Quality method, for continuous quality improvement.MethodsWe used cluster randomization to assign 6 neonatal intensive care units (ICUs) to reduce nosocomial infection (infection group) and 6 ICUs to reduce bronchopulmonary dysplasia (pulmonary group). We included all infants born at 32 or fewer weeks gestation. We collected baseline data for 1 year. Practice change interventions were implemented using rapid-change cycles for 2 years.ResultsThe difference in incidence trends (slopes of trend lines) between the ICUs in the infection and pulmonary groups was - 0.0020 (95% confidence interval [CI] - 0.0007 to 0.0004) for nosocomial infection and - 0.0006 (95% CI - 0.0011 to - 0.0001) for bronchopulmonary dysplasia.InterpretationThe results suggest that the Evidence-based Practice for Improving Quality method reduced bronchopulmonary dysplasia in the neonatal ICU and that it may reduce nosocomial infection.

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