From Pathway to Practice: Implementing Evidence-Based Quality Improvement for ELBW Care

Objective: Structured clinical guidelines improve outcomes in neonatal care. At Oklahoma Children's Hospital, the need for a standardized approach to extremely low birth weight (ELBW) infants became urgent due to rising acuity and care variability. Despite existing nursing protocols, the unit lacked comprehensive interdisciplinary guidelines for ELBW infants. Key goals included reducing intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). Study Design: Multidisciplinary teams developed eight clinical pathways using evidence-based models. The Appreciative Inquiry framework was used to engage staff and build consensus. The interdisciplinary workgroups conducted literature reviews, developed system-based protocols, and facilitated iterative revisions. Pathways were implemented and were supported by education, exposure, and saturation strategies. Key metrics were benchmarked using Vermont Oxford Network (VON) data, with IVH, BPD, and ROP as outcome measures and mortality as a balancing measure. Real-time data collection was used to drive further improvement. PDSA (plan, do, study, act) cycles targeted thermoregulation, line placement, early surfactant administration, and glucose and oxygen management. Results: = 130) showed a reduction in severe IVH (from 25 to ∼20%), a 7% reduction in grade 2 and grade 3 BPD, consistently low ROP rates (