{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T11:19:36Z","timestamp":1784027976664,"version":"3.55.0"},"reference-count":18,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,2,1]]},"abstract":"\n BACKGROUND:<\/jats:title>\n Premature infants have bradycardia and\/or desaturation events due to apnea of prematurity that resolve as the infants mature. Despite American Academy of Pediatrics guidelines recommending a standard \u201cevent-free\u201d period before discharge, length of observation in our Intensive Care Nursery was variable. By June 2018, for infants born &lt;36 weeks\u2019 gestation in the Intensive Care Nursery, we aimed to standardize time to discharge after the last documented event at 5 days, when the baseline mean was 3.6 days (range 0\u20136 days).<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n A quality-improvement team used the Model for Improvement. Plan-do-study-act cycles improved nursing documentation of events and standardized discharge criteria after consensus on operational definitions. The outcome measure was days to discharge after last documented event. Process measures included percentage of events documented completely and correctly in the electronic medical record. Balancing measure was length of stay after 36 weeks\u2019 corrected gestational age. We used statistical process control.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n The baseline event watch ranged from 0 to 6 days. After defining significant events, documentation expectations, and consensus on a 5-day \u201cwatch\u201d before discharge, the event watch range narrowed with a mean that shifted from 3.6 to 4.8 days on X-bar S statistical process control chart. Completeness of documentation increased from 38% to 63%, and documentation of significant events increased from 38% to 88%. Length of stay after 36 weeks\u2019 corrected gestational age was unchanged, and nursing satisfaction improved.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n We found decreasing variation in the management of apnea of prematurity while simultaneously improving staff satisfaction. Next steps include revising electronic medical record flowsheets and spread to network NICUs.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/peds.2019-0861","type":"journal-article","created":{"date-parts":[[2020,1,15]],"date-time":"2020-01-15T13:25:13Z","timestamp":1579094713000},"source":"Crossref","is-referenced-by-count":10,"title":["Reducing Variation in the Management of Apnea of Prematurity in the Intensive Care Nursery"],"prefix":"10.1542","volume":"145","author":[{"given":"Katherine","family":"Coughlin","sequence":"first","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Penn Neonatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Posencheg","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Penn Neonatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Orfe","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Penn Neonatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Whitney","family":"Zachritz","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Penn Neonatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaqueline","family":"Meadow","sequence":"additional","affiliation":[{"name":"Division of 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