Delivery Room Quality Improvement Project Improved Compliance with Best Practices for a Community NICU.

Charles W Sauer,Mallory A Boutin,Aayah N Fatayerji,James A Proudfoot,Nabil I Fatayerji,David J Golembeski

doi:10.1038/srep37397

Abstract

A Quality Improvement bundle was implemented with the goal of standardizing the multidisciplinary approach to delivery room management. We used a Pre-Post Quality Improvement initiative with the following aims: (1) Placement of a functioning pulse oximeter by two minutes after birth, (2) Delayed intubation, (3) Normothermia on Neonatal Intensive Care Unit Admission, (4) Use of a pre-brief, debrief, and delivery room checklist. Data was collected for 548 infants, which represents every admission to the Palomar Rady Children’s Hospital Neonatal Intensive Care Unit during the 35 month study period from January 1, 2010 to November 30, 2012. The intervention began on May 1, 2011. The objective of increasing the frequency of each goal was met. A significant decrease in rates of retinopathy of prematurity in our post-intervention group was found. Odds ratio 0.00 (0.000, 0.696) p = 0.008. However, this was not confirmed in the multivariable analysis so should be interpreted with caution. This quality improvement project had a positive effect on newborn resuscitation at Palomar Medical Center.

Highlights

The transition from fetus to neonate is a time of significant physiologic adaptation, especially for babies born prematurely[1,2]
An expert panel identified the need for delivery room resuscitation improvements in a network of neonatal intensive care units
Based on the recommendation of the panel, training was done for the delivery room team in order to achieve the following goals: (1) Placement of a functioning pulse oximeter by two minutes after birth to facilitate supplemental oxygen administration, (2) Delayed intubation in preference of using continuous positive airway pressure (CPAP) with the goal of surfactant avoidance in the delivery room, (3) Normothermia at Neonatal Intensive Care Unit (NICU) admission, (4) Promotion of teamwork and communication between the obstetrician, labor and delivery staff, and the neonatal resuscitation team via the use of a team pre-brief, debrief, and delivery room checklist (Fig. 1)

Summary

Introduction

The transition from fetus to neonate is a time of significant physiologic adaptation, especially for babies born prematurely[1,2]. This period of transition has been referred to as the “Neonatal Golden Hour” and begins in the delivery room. Optimizing delivery room care for newborns can improve both short term and long term outcomes. The goal of this quality improvement (QI) project is the implementation of a standardized multidisciplinary approach to delivery room management

Objectives

Methods

Results

Conclusion