Identifying, Developing, and Quantifying Single-Day Quality Measures within the Neonatal ICU

Assessing safety culture, while valuable, may neglect day-to-day variation in the experiences of individual care providers. Understanding day-to-day variation may be a key to understanding and improving the single-day quality (SDQ) of care providers. The goal of this study was to: (1) determine the variables that contribute to the quality of each day (SDQ), (2) determine the validity and perceived importance of each contributing variable, and (3) determine how well care providers can predict whether the variables will have an effect on their SDQ. Interviews of NICU nurses and literature reviews were used to identify six variables perceived to influence SDQ. A survey tool assessing the six variables and SDQ was developed. Nurses were then surveyed at the beginning and end of each shift, providing a prospective (pre) and retrospective (post) assessment of all six variables plus an overall SDQ rating. The results identified which variables predicted or contributed to SDQ. Although the predictive power of the six variables differed between prospective and retrospective estimations, environmental factors and patient acuity were consistent contributors to SDQ. Overall, understanding the contributors to day-to-day variation can be used to as means to improve the healthcare provider’s SDQ and the safety of patient care.