This project was selected because Pneumothorax is an adverse outcome collected on all NICU admissions. Tara collects outcome data for the VON database on all NICU admissions and tracks them on the NICU Quality Dashboard. The incidence rate for pneumothorax was 2.7% in CY 23 and 4.7% in CY 24.

The upwards trend was identified through tracking and trending and brought to QAPI in November 2024. The workgroup began in January 2025.

The project's focus was on a potentially preventable adverse outcome for neonates and is supported by our service standards of safe and efficient care.

Reducing pneumothorax takes courage and credibility to review current practice and make process changes to align more closely with the Neonatal Resuscitation Program.

The data was reviewed to determine the population with the most impact for improvement. The time of occurrence (hours of life), gestational age, and delivery room interventions were collected and analyzed. Most pneumothoracies occurred in infants >35 weeks of gestation, within the first 6 hours of life (transition period), and had received positive pressure ventilation as an intervention in the delivery room. 

The project team was the process owner for deliveries. NICU charge nurses and RT’s attend most deliveries, and NNP and physicians enter orders for respiratory support in the NICU. They were the process owners and stakeholders.

Describe the results/outcomes:

Plan do study act (PDSA) 1- Place a pulse oximeter within 2 minutes of life to assist with respiratory support decision making.

PDSA 2- Current practice default was to start CPAP immediately for increased work of breathing or poor color/low SpO2. NRP states to provide O2 and consider CPAP. A PDSA Cycle 2 – Delivery Room Flow Diagram was created with the process change, and the new inclusion criteria were changed to include a new population of>36 weeks.

Results that were noted were a 54% reduction in the incidence of pneumothorax between CY24 and CY25.