New evaluation shows quality improvement project is improving care for premature babies
More mothers and babies born prematurely in South West England are receiving lifechanging care interventions thanks to an ambitious project designed to reduce brain injury and death in vulnerable preterm babies, according to a new evaluation. The project is also demonstrating how effective a quality improvement (QI) approach can be at improving perinatal care.
Perinatal Excellence to Reduce Injury in Premature Birth (PERIPrem) is a collaborative project by the South West Academic Health Science Network (South West AHSN), West of England Academic Health Science Network (West of England AHSN), and South West Neonatal Network (SWNN), comprising a bundle of 11 evidence-based interventions for mothers and preterm babies that can be implemented by perinatal teams using QI methodology.
A new evaluation, conducted independently by the South West AHSN and published this month in the British Medical Journal Open Quality, indicates how the PERIPrem bundle and QI approach has increased the uptake of these 11 interventions in 12 NHS Trusts across the South West, as well as improved perinatal team culture. By the end of the evaluation period, 26% more mothers and babies born prematurely in the South West received the care interventions they were eligible for, compared to before PERIPrem started.
Preterm birth is the single biggest cause of infant mortality and newborn brain injury in England. The NHS is aiming to reduce stillbirth, maternal and neonatal mortality, and serious brain injury in newborn infants by 50% by 2025.
The PERIPrem bundle of interventions includes ensuring birth is in the right place, optimally timed antenatal corticosteroids, magnesium sulphate, optimal cord management, thermoregulation, early maternal breast milk, volume-targeted ventilation, caffeine, prophylactic hydrocortisone, probiotics, and intrapartum antibiotics prophylaxis – each proven to have a significant impact on brain injury and/or mortality rates in babies born prematurely.
Currently the uptake of these interventions and perinatal care for preterm babies varies across perinatal units in the UK. With its evidence base and QI approach, PERIPrem offers a unique opportunity for perinatal units to improve their care of – and outcomes for – babies born early.
Working together, the South West AHSN, West of England AHSN and SWNN supported 12 NHS Trusts across the South West to implement PERIPrem in their maternity and neonatal units during an implementation phase from July 2020 to June 2021, to care for babies born before, or at, 34 weeks’ gestation. The approach was co-produced with the perinatal teams in these units, with parents who have experienced preterm birth, and with the wider regional clinical community.
Our evaluation combined mixed methods data analysis, staff surveys on teamwork, and interviews with maternity, neonatal and obstetric staff and QI coaches, as well as comparing changes at the end of the implementation phase to data from January 2019, before PERIPrem began.
The findings suggest PERIPrem’s QI approach is effective at improving care for preterm babies and nurturing perinatal teams by enhancing their skills. During the 11-month implementation phase, there were significant improvements in implementation of several interventions including volume-guided ventilation, early breast milk, probiotics and prophylactic hydrocortisone, and a steady improvement in optimal place of birth for extremely preterm babies. By summer 2021, delivery of ten out of the 11 PERIPrem bundle interventions had improved.
Culture within perinatal teams had also improved, with an enhanced common language and situational monitoring. Staff were empowered by opportunities to increase their knowledge, skills and confidence in preterm birth and infant care, and benefited from strategic cues, protected time, and access to tailored resources and QI support.
Despite the challenges of COVID-19 at the time, data from the National Neonatal Audit Programme highlights the impact of improved perinatal team working across the South West region, particularly in optimal cord management, where the South West is the best performing region nationally by a considerable margin.
“The PERIPrem collaborative illustrates that investment in NHS perinatal teams to enable growth in knowledge, teamworking skills and QI capability, to implement the most effective new treatments in their hospitals, accelerates and improves access to life-altering healthcare for preterm babies and their families”, said Professor Karen Luyt, PERIPrem Clinical Lead.
“This evaluation advances our understanding about the processes that underpin successful implementation of evidence-based healthcare, designed to improve survival and reduce brain injury for the smallest and most vulnerable babies.”
PERIPrem and its evaluation demonstrate how the South West AHSN is building capability in its local health and care system. “The PERIPrem project is embedding data, evidence and evaluation into the core of its design and delivery”, said Dr Hayley McBain, South West AHSN Evaluation Lead. “It’s one example of how the South West AHSN is supporting its partners to develop and use learning system methods.”
Tasha Swinscoe, Chief Executive of the West of England AHSN, said: “We are very proud that PERIPrem – originally developed as a model in the West of England region – is achieving lifesaving and life changing results for pre-term babies across the South West. With PERIPrem resources being endorsed by the National Neonatal Nurses Association, and our close working relationship with the British Association of Perinatal Medicine and NHS England’s patient safety team, we hope to see the core elements of PERIPrem adopted and spread across more maternity systems.”
As key innovation arms of the NHS, the South West and West of England AHSNs are delivering PERIPrem as part of the NHS England Maternity and Neonatal Safety Improvement Programme (MatNeoSIP). The findings of the new evaluation indicate PERIPrem is an ideal way for the NHS to achieve the improvement in preterm perinatal care it is aiming for, and the learnings will support other AHSNs and NHS Trusts across the UK as they consider implementing PERIPrem similarly in their regions.
For more information about the evaluation please contact South West AHSN Evaluation Lead, Dr Hayley McBain (firstname.lastname@example.org).
Learn more about each intervention in the PERIPrem bundle on the West of England AHSN website, and keep up-to-date with the latest PERIPrem news on Twitter by following @sw_ahsn, @weahsn, and @peri_prem.
PERIPrem is built on the QI theory and community of PReventing Cerebral palsy in Pre-Term labour (PReCePT), a project developed by West of England AHSN in collaboration with University Hospitals Bristol NHS Foundation Trust. The programme was funded by NHS England and was subsequently selected for adoption and spread across England during 2018-20 via the national AHSN Network. Learn more here.