Quality improvement is a new and emerging field of study in hospitals across the world. NICUs in particular are focusing on how to improve patient care and outcomes, and how to do so sustainably. The following is a guest post from Dr. David Paul, a Section Editor for BMC Pediatrics, explaining why BMC Pedatrics thinks quality improvment studies are important and why we want to publish them. Please read what he has to say, and consider submitting your study to BMC Pediatrics!

What is the motivation for reading and or publishing in BMC Pediatrics? There are a myriad of resources available to aid clinicians that can potentially be used to improve patient care. Open access publishing has the ability to rapidly communicate medical advances to providers throughout the world. The needs of clinicians in North America and those in Sub-Saharan Africa may be very different, yet the desire to make evidence-based decisions and improve care and outcomes within a hospital system, region or country is universal.

Improving neonatal care and outcomes starts with making informed decisions based on the best medical evidence available. Published medical evidence includes many different study designs ranging from case reports to double blind randomized placebo controlled trials. Although randomized controlled trials remain the gold standard for changing practice, they are expensive to conduct, may not be generalizable beyond the specific patient population included in a trial, and the results may not be able to be quickly accessed in many regions of the world. There is also emerging evidence that big trials in neonatal medicine may have some inherent bias based on the study sample ultimately recruited [1]. A study’s patient sample is often determined, and sometimes limited, based on informed consent requirements [2]. As an example, a recent trial of early blood pressure management failed to meet the planned study enrollment due to difficulties in obtaining informed consent [3]. Certainly, randomized double blind controlled trials will remain the “gold standard” for improving neonatal care. In addition to randomized trials, new methodologies for changing practice and systems are needed in order to make rapid evidence based advances. Rigorously performed quality improvement initiatives can potentially fill some of this void.

There has been an ever-increasing emphasis on patient safety and quality improvement in perinatal care[4]. This has lead to countless examples of improvement in pediatric, neonatal and obstetric care. Publication of these improvement stories has allowed other providers to follow suit and implement similar changes. Furthermore, organizations such as the American Board of Pediatrics are institutionalizing quality improvement by including it as part of the Maintenance of Certification process. As quality improvement continues to evolve and becomes a universal part of pediatric and neonatal care, publication of these initiatives are needed so clinicians can learn from others’ experiences.

BMC Pediatrics welcomes the submission of manuscripts related to quality improvement in Neonatal Intensive Care. These manuscripts will undergo standard peer-review and be held to established rigorous criteria for BMC Pediatrics. Submitted projects should be prospective in nature and go beyond simply looking at changes over time in two epochs (before and after an intervention). Important components of submitted manuscripts will include detailed descriptions of: the problem leading to initiation of the quality improvement initiative, study sample and context, intervention, process measures, statistical analysis including process control, potential balancing measures, and a description of plans for sustainability. Published manuscripts may include quality improvements ranging from a single center to a region or country.

Since the introduction of surfactant replacement and antenatal corticosteroids, improvement in neonatal outcomes has been only incremental over the past few decades [5-6]. Surfactant and corticosteroids are examples of breakthrough interventions, which when universally adopted and appropriately applied, have the ability to have major impacts on survival and outcome. Progress in developing these types of interventions is inherently slow. In the meantime, publication of peer reviewed, rigorously designed, quality improvement initiatives will allow the global neonatal community to learn from other’s experiences, advance and improve care. As more attention is paid to improving system based outcomes, collective improvement in outcomes will follow. BMC Pediatrics welcomes your important contribution to this process.

David A. Paul, MD
Editor, Neonatology Section, Biomed Central Pediatrics
Director of Neonatal Research, Christiana Care Health System, Newark, DE, USA
Professor of Pediatrics, Thomas Jefferson College of Medicine, Philadelphia, PA, USA

Correspondence:
David A. Paul, MD
MAP 1, 217
4745 Ogletown Stanton Road
Newark, DE 19713
302 733 2410
dpaul@christianacare.org
________________________________________

References:

1. Rich W, Finer NN, Gantz MG, Newman NS, Hensman AM, Hale EC, Auten KJ, Schibler K, Faix RG, Laptook AR, Yoder BA, Das A, Shankaran S, SUPPORT and Generic Database Subcommittees of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research,Network: Enrollment of extremely low birth weight infants in a clinical research study may not be representative. Pediatrics 2012, 129(3):480-484.

2. Vain NE, Barrington KJ: Feasibility of evaluating treatment of early hypotension in extremely low birth weight infants. J Pediatr 2012, 161(1):4-7.

3. Batton BJ, Li L, Newman NS, Das A, Watterberg KL, Yoder BA, Faix RG, Laughon MM, Van Meurs KP, Carlo WA, Higgins RD, Walsh MC, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research,Network: Feasibility study of early blood pressure management in extremely preterm infants. J Pediatr 2012, 161(1):65-69.e1.

4. Kaplan HC, Ballard J: Changing practice to improve patient safety and quality of care in perinatal medicine. Am J Perinatol 2012, 29(1):35-42.

5. Hintz SR, Poole WK, Wright LL, Fanaroff AA, Kendrick DE, Laptook AR, Goldberg R, Duara S, Stoll BJ, Oh W: Changes in mortality and morbidities among infants born at less than 25 weeks during the post-surfactant era. Arch Dis Child Fetal Neonatal Ed 2005, 90(2):F128-33.

6. Horbar JD, Carpenter JH, Badger GJ, Kenny MJ, Soll RF, Morrow KA, Buzas JS: Mortality and neonatal morbidity among infants 501 to 1500 grams from 2000 to 2009. Pediatrics 2012, 129(6):1019-1026.