Quality Improvement Project: Patent Ductus Arteriosus (PDA) Score Implementation for Targeted Management of PDA in Preterm Infants

Abstract

Abstract Due to the variation of practice in managing Patent Ductus Arteriosus (PDA) in preterm infants, we have performed a quality improvement project to standardise PDA management using a PDA Score (PDAsc). PDAsc consisted of clinical and echocardiographic parameters that reflected systemic hypoperfusion and pulmonary overcirculation. An echocardiogram was performed at 48–120 hours of life. The model for improvement was followed, and five PDSA cycles were completed. Process measures included the percentage of infants having an echocardiogram at 48–120 hours of life and the rate of PDA treatment. Outcome measures included PDA closure and treatment rates. Implementing PDAsc increased the percentage of early echocardiograms from 58% (36/45) to 79% (30/38). There was a reduction in the PDA treatment rate from 54–44%. The rate of PDA closure stayed the same at 41% (16/39) and 42% (15/36) before and after PDAsc, respectively. In conclusion, PDAsc is an objective tool that facilitates decision-making and standardisation of PDA management. It helps provide early targeted treatment of haemodynamically significant PDA (hsPDA) while avoiding unnecessary treatment of non-hsPDA.