P.136 Implementation of BC Children’s Hospital’s intraventricular hemorrhage of prematurity management pathway: a quality improvement analysis

Abstract

Background: Early placement of a ventricular access device (VAD) may decrease the need for permanent CSF diversion and improve cognitive outcomes in premature infants with intraventricular hemorrhage. In 2019, BC Children’s Hospital implemented a multidisciplinary early intervention pathway for these infants. This study evaluated process and compliance measures related to protocol implementation. Methods: A retrospective quality improvement chart review of enrolled infants was performed. Select measures included time to neurosurgery consult and intervention, compliance with VAD tapping and ultrasound protocols, overall ultrasound resource use, and complications. Results: Sixteen patients were included. Median time to VAD insertion was 6 days (IQR 4-9.5), greater than the 3-day target. Transfer time from peripheral NICUs and access to OR time were found to be important reasons for delay. Patients received a median 92.2% (IQR 85.1-100%) of the ultrasounds required by protocol, with a median of 36.5 (IQR 29-43.25) ultrasounds per patient. VAD tapping was 88.8% (IQR 75.6-94.8%) compliant; most protocol deviations were indicated taps not performed due to technical difficulties. Conclusions: Compliance with the new protocol was satisfactory. Areas for improvement include continued education at peripheral NICU sites to minimize transfer delays, improved access to the OR, and maintenance of technical skills amongst our NICU partners.