Design And Quality Improvement Of Critically Ill Neonatal Database

Objective: To design,implement and enhance a characteristic neonatal clinical database according to the actual situation of NICU in Zhongda Hospital,Southeast University.Based on the neonatal database,perinatal information,severity,admission and discharge outcomes of critically ill neonates who were transferred from 2017 to 2020 were analyzed.The aims are to evaluate the effect of quality improvement,to explore the implementation of process evaluation,to provide data support for continuous quality improvement,and to provide practical basis for the enhancement direction of regional neonatal transport system with the basis of quality improvement of the neonatal transport process.Methods:(1)A characteristic neonatal clinical database was designed and operated.(2)Based on neonatal database,newborns transferred to the NICU of Zhongda Hospital,Southeast University before the initial quality improvement of neonatal transport from January 2017 to December 2018 were selected as the baseline group to explore the deficiencies of neonatal transport.(3)Based on the above deficiencies,a database improvement study was conducted to explore the preliminary quality improvement of neonatal transport since 2019.Neonates who had implemented the preliminary quality improvement from January 2019 to December 2020 were selected as the observation group to analyze the effect of quality improvement.And transport data from 2017 to 2020 was analyzed.The perinatal information,age of transport,distance of referral,disease type and outcome of the subjects were derived from neonatal database by retrospective statistical analysis method,and analyzed and processed by SPSS 22.0 software.Results:(1)The characteristic neonatal clinical database is successfully designed and operated.(2)Based on neonatal database,between 2017 and 2018,infants through intrahospital transport have higher incidence rates of mild and moderate hypothermia(mild28.86% vs 23.22%,moderate 31.58% vs 18.62%)and hypoglycemia(25.98% vs 21.9%)than those through interhospital transport.(3)After the initial quality improvement of neonatal transport,the incidence of hypoglycemia decreases(23.08% vs 14.99%),the proportion of intrahospital transport increases(29.12% vs 41.13%),and the incidence rates of premature infants(30.6% vs 37.76%)and intraventricular hemorrhage(17.1% vs 25.45%)increase(P<0.05).There is no significant difference in cure/mortality rate,transport distance,length of hospital stay,incidence of respiratory distress syndrome,hypoxic ischemic encephalopathy,and neonatal critical illness scores of neonates(P<0.05).Data from 2017 to 2020 shows that among infants of admission age<24 h,the percentage of intrahospital transport is higher(77.76% vs 28.34%);intrahospital transport babies with diagnosis of premature infants(47.51% vs 26.37%),neonatal respiratory distress syndrome(19.04% vs 11.92%),neonatal wet lung(9.35% vs 4.89%)are higher(P<0.05).Conclusion:(1)Neonatal clinical database is conducive to neonatal transport research.The database improvement based on neonatal transport lays a foundation for further improvement of the database in the future,on which quality control and follow-up studies can be carried out continuously in the future.(2)Neonatal transport centered to the NICU of Zhongda Hospital,Southeast University has a high success rate,a wide coverage and a good overall prognosis.The initial quality improvement of neonatal transport can effectively reduce the incidence of admission hypoglycemia,and further quality improvement can reduce the fatality rate.