Intraventricular
Hemorrhage
Focused on reducing the incidence of severe intraventricular hemorrhage (sIVH) in Tennessee’s tiniest babies.
Intro
The first project in the Tennessee Tiniest Baby Bundle is the prevention of severe intraventricular hemorrhage (sIVH). Intraventricular hemorrhage is bleeding inside or around the ventricles of the brain. Severe IVH is defined as a Grade III or IV hemorrhage and is considered one of the most concerning complications of preterm birth. Level III and IV NICUs from across Tennessee have come together to achieve a 25% relative reduction (from the respective facility’s baseline over the past 3 years) in sIVH in this population by March of 2024. TIPQC is proud to have teams of healthcare professionals and parents participate in this very important project. This project, like so many of the other TIPQC projects, is aimed at improving care for babies and families one project at a time.
Tennessee NICUs Join Together to Improve Care for the Tiniest Babies
The Tennessee Initiative for Perinatal Quality Care (TIPQC) just completed the state Severe Intraventricular Hemorrhage (sIVH) Project, improving the outcomes of infants born less than or equal to 29.6 weeks gestational age.
During the project, which began December 2022 and moved to sustainment June 2024, all the Level Ill and IV Neonatal Intensive Care Units (NICUs) from across Tennessee worked to achieve a 25% relative reduction (facility’s previous 3-year baseline) in slVH in this population, as well as an overall 25% reduction in mortality.
Two (2) hospitals achieved a Platinum QI rating which consisted of active project participation including huddles and coaching calls, monthly outcome and structure data capture, data driven QI work, clinical change implementation, and decreasing the rates of sIVH as well as decreasing mortality:
- University of Tennessee Medical Center, Knoxville
- Methodist LeBonheur Germantown Hospital
Five (5) hospitals received a Gold QI Rating, having achieved 5 out of 7 of the above criteria, which included:
- Baptist Memorial Hospital
- East Tennessee Children’s Hospital
- Jackson Madison County General Hospital
- Monroe Carell Jr. Children’s Hospital
- Parkridge East Hospital
Silver QI Awards were given to:
- Niswonger Children’s Hospital
- Regional One Health
- TriStar Centennial Medical Center
Bronze QI Ratings were awarded to:
- Ascension St. Thomas Midtown
- Children’s Hospital at Erlanger
All hospitals improved care to reduce sIVH. Congratulations to all the teams!
IVH Key Driver Diagram
This diagram provides an overview of primary and secondary drivers with interventions.
TTB-sIVH Data Entry Form
This clinical care checklist provides guidance and data to collect for infants born at <=29.6 weeks of gestation.
IVH Key Driver Summary Diagram
This version of the Driver Diagram provides a more specific and summarized version of the drivers and interventions.
IVH State IRB Approval
Review Determination from State of Tennessee Institutional Review Board.
IVH Protocol
This protocol provides the description for the collaborative framework for this project (for use with your IRB, if needed).
- Baptist Memorial Hospital for Women
- East Tennessee Children’s Hospital *
- Erlanger Health System
- Jackson-Madison County General Hospital *
- Methodist LeBonheur Germantown Hospital
- Monroe Carell Jr Children’s Hospital at Vanderbilt
- Niswonger Children’s Hospital
- Parkridge East
- Regional One Health *
- St. Thomas Midtown
- TriStar Centennial Medical Center *
- University of Tennessee Medical Center Knoxville *
State Project Leaders
Parul Zaveri, MD is a neonatologist at Regional One Medical Center and Assistant Professor, University of Tennessee Health Science Center.
Marcelo Rains, MD is a neonatologist at Erlanger Health System and an Affiliated Assistant Professor, University of Tennessee College of Medicine Chattanooga.
Previous State Infant Medical Director, Scott Guthrie, MD, is a neonatologist for Vanderbilt University Medical Center working at Jackson-Madison County General Hospital and Professor of Clinical Pediatrics, Vanderbilt School of Medicine.