Health care quality improvement collaboratives implement care bundles to target critical parts of a complex system to improve a specific health outcome. The quantitative impact of each component of the care bundle is often unknown. Orchestrated testing (OT) is an application of planned experimentation that allows simultaneous examination of multiple practices (bundle elements) to determine which intervention or combination of interventions affects the outcome. The purpose of this article is to describe the process needed to design and implement OT methodology for improvement collaboratives. Examples from a multicenter collaborative to reduce central line-associated bloodstream infections highlight the practical application of this approach. The key components for implementation of OT are the following: (1) define current practice and evidence, (2) develop a factorial matrix and calculate power, (3) formulate structure for engagement, (4) analyze results, and (5) replicate findings.

Component (thermodynamics)

Replicate

10.1177/1062860615609994

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Citations (9)

Asymmetry of Cerebral Blood Flow Velocity in Low Birth Weight Infants

Neonatology (2004)

Jyothi Swarup Robyn Baker Beverly Brozanski Toby Yanowitz

In premature infants, intraventricular hemorrhage occurs more commonly in the left than the right hemisphere. We have demonstrated previously that cerebral blood flow velocity is lower in the left than the right middle cerebral artery in the first few hours after birth. This may be due to the open ductus arteriosus.To test the hypothesis that blood flow velocity is lower in the left than the right middle cerebral artery only when the ductus arteriosus is open.Infants born at 25-33 weeks' gestation were enrolled. Middle cerebral artery blood flow velocities and coefficients of variation were measured on the left, followed by the right, on days 1 and 7 of life. Echocardiography identified 67 infants (25-33 weeks, 517-2,371 g) whose ductus arteriosus was open on day 1 and closed on day 7.Systolic (26.4 +/- 7.4 vs. 29.6 +/- 7.2 cm/s), mean (12.4 +/- 4.0 vs. 15.6 +/- 4.6 cm/s) and end-diastolic (5.3 +/- 2.2 vs. 6.8 +/- 2.9 cm/s) blood flow velocities were lower (p < 0.01) and the corresponding coefficients of variation were higher (p < 0.01) on the left on day 1. Neither the absolute Doppler blood flow velocities nor the coefficients of variation differed between the left and right sides on day 7.Blood flow velocity is lower and more variable in the left compared to the right middle cerebral artery on day 1 of life in premature infants. These differences are not found on day 7. We speculate that this difference is due to the associated ductus arteriosus patency.

10.1159/000082290

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Citations (11)

Predicting Risk of Infection in Infants with Congenital Diaphragmatic Hernia

The Journal of Pediatrics (2018)

Karna Murthy Nicolas Porta Eugenia K. Pallotto Natalie E. Rintoul Sarah Keene

10.1016/j.jpeds.2018.07.032

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Citations (7)

Does the initial surgery for necrotizing enterocolitis matter? Comparative outcomes for laparotomy vs. peritoneal drain as initial surgery for necrotizing enterocolitis in infants < 1000 g birth weight

Journal of Pediatric Surgery (2019)

Toby Yanowitz Kevin M. Sullivan Anthony J. Piazza Beverly Brozanski Isabella Zaniletti

Necrotizing Enterocolitis

10.1016/j.jpedsurg.2018.12.010

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Citations (13)