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Quality improvement program led to better infant sleep behaviors at children's hospitals

A quality improvement program led to better infant sleep behaviors in six Ohio-based hospitals, according to recent findings published in Pediatrics.

“To our knowledge, this is the first [quality improvement] collaborative for children’s hospitals in one state to focus on modeling appropriate sleep behaviors for families,” Jamie R. Macklin, MD, in the division of hospital pediatrics at Nationwide Children’s Hospital in Columbus, Ohio, and colleagues wrote. “Although safe sleep rates did not reach our goal of 90%, significant improvement was observed over a short period of time.”

In 1992, the American Academy of Pediatrics (AAP) recommended that infants be placed to sleep in a nonprone position to reduce risk for sudden infant death syndrome. However, a recent study showed that more than half of inpatient health care providers do not model recommended sleeping practices for infants. In response to the state’s poor infant mortality rate, the Ohio chapter of the AAP implemented a quality improvement safe sleep program in all hospitals affiliated with the Ohio Children’s Hospital Association.

The AAP asked hospitalists from each of the six children’s hospitals to form safe sleep teams within their institution. Teams collected information on infant age, sleep position and environment at baseline and then every week for 12 months. They also implemented at least three “Plan-Do-Study-Act” cycles. Afterward, the researchers calculated changes in safe sleep practices over time.

The teams collected 5,343 audits in total for 856 sleeping infants at baseline and 189 infants at 1-year. At baseline, 32.6% of infants followed AAP recommendations compared with 58.2% at the end of the 12 months (P < .001). Presence of empty cribs, which was the most common positive behavior at 1 year, increased from 38.1% to 67.2% (P < .001). Loose blanket use, which was the most common adverse behavior at baseline, decreased from 77.8% to 50%.  Audits also demonstrated an increase in education about safe sleep practices from 48.2% to 75.4% (P < .001).

“Our baseline data demonstrated that inpatient pediatric units in free-standing children’s hospitals do not routinely follow the AAP safe sleep guidelines,” the researchers wrote. “Given our country’s and state’s poor infant mortality rates, it is imperative that health care professionals model appropriate infant safe sleep behaviors and provide education and recommendations on continuing these practices in the home.” – by Will Offit

Disclosure: The researchers report no relevant financial disclosures.