The Evidence-based Practice for Improving Quality (EPIQ) program was launched in 2003 by the Canadian Neonatal Network to improve outcomes of infants born <33 weeks’ gestation who are at high risk of mortality and morbidity. Since then, EPIQ has undergone four main phases, each one building on the lessons learned from the previous. Join us on our EPIQ journey.
Review, data, training, engagement in a randomized trial
The EPIQ process was introduced in a study aimed at reducing incidences of nosocomial infection (NI) or Bronchopulmonary Dysplasia (BPD) in 12 tertiary NICUs across Canada (Lee et al 2009). Members received training in evidence-based practice changes and team building. These new skills were soon applied while assembling interdisciplinary teams, gathering evidence from the literature, targeting specific practices, and implementing the changes. EPIQ teams consisted of Neonatologists, Nurses, Respiratory Therapists, Research Assistants, Dieticians, and members of other disciplines. Practice Changes were implemented using the Plan-Do-Study-Act (PDSA) method. The Coordinating Centre promoted communication within and amongst groups via organizing teleconferences, meetings, e-mail discussion groups, and so on. Through these combined efforts the incidences of both NI and BPD were significantly reduced in comparison to non-participating sites (Lee et al. 2009).
The Evidence-based Practice Identification and Change / Partnerships for Health Systems Improvement (EPIC/PHSI) was a 3-year knowledge transfer / quality improvement project jointly funded by the Canadian Institutes of Health Research (CIHR) and the Michael Smith Foundation for Health Research. The project took place from 2006 - 2008 with the aim to improve clinical practice in neonatal intensive care units (NICUs) by identifying and implementing evidence-based practices.
The research questions that were addressed from this study were:
- Generalizability: Can EPIQ be generalized for application to all NICUs? Specifically, can successful strategies from the Infection Study be used to develop a generalized practice change for rapid adoption by other NICUs.
- Sustainability: Can EPIQ-reduced hospital acquired infection rates be sustained over time?
- National Application: Can a national system for quality improvement based on the EPIQ model successfully support improvement on an on-going basis?
Review, data, training, engagement, expansion
EPIQ II was a national prospective Quality Improvement cohort trial undertaken in 25 of 27 NICUs across Canada. The objective of EPIQ II was to assess the generalizability and impact of EPIQ on the outcomes of extremely preterm infants. EPIQ II took place between April 2008 and September 2012, with one year of baseline data collection, six months of study preparation, and 3 years of an intervention phase (Lee et al. 2014).Through a collaborative process, sites continually identified, appraised, and implemented evidence-informed quality improvement initiatives. The five major morbidities in the neonatal population were targeted – bronchopulmonary dysplasia (BPD), severe neurologic injury (SNI), severe retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC) and nosocomial infection (NI).
All above plus Sentinel event review and Site visits
EPIQ III was built on past successes and challenges. During the implementation, strategies were identified to sustain the momentum of continuous Quality Improvement in Canadian tertiary NICUs. Additional activities were added to the existing EPIQ- II program. These included review of individual hospital’s outcome rates by designated steering committee members and site leads; site visits by EPIQ teams to NICUs with a similar population-base, local sentinel review of each incidence of targeted morbidities and sites completion of PDSA cycles per year. EPIQ III took place in a 5 year study period from 2013 to 2017 in which we identified that with the help of a collaborative, multidisciplinary, nationwide Quality Improvement program the major morbidities were reduced in extremely low GA age neonates in Canada (Shah et al. 2018). Our program EPIQ-3 was a successful and sustainable model of effecting care process improvement and outcome gains for preterm neonates.