Improving the care of term babies at risk of hypoglycaemia: A microsystem approach.

Abstract

Neonatal hypoglycaemia is a common problem, often requiring admission to the neonatal intensive care unit (NICU). Our aim was to reduce term admissions to NICU for hypoglycaemia by 50% over 4 years. Inborn term babies from 1 January 2015 to 31 December 2018 were included. Using quality-improvement methodology, we designed interventions based on human factors to incorporate best practice recommendations for babies at-risk of hypoglycaemia. This included standardisation of local guidelines, introduction of educational programmes to reiterate changes to practice and a multidisciplinary steering group to review term admissions to better understand the cause of failure of the maternal-neonatal pathway. The outcome measures were the number of term babies admitted to NICU for hypoglycaemia and the proportion of these babies not requiring intravenous (IV) dextrose. Run charts were used to monitor hypoglycaemia admissions and the impact of each intervention. There was an overall reduction in the number of term babies admitted to NICU for hypoglycaemia from 36 babies in 2014 (baseline) to 5 babies in 2018. The percentage of babies admitted to the neonatal unit who did not require IV dextrose decreased from 22/36 (61%) in 2014 to 0/5 (0%) in 2018. Admissions from the delivery suite decreased from 21/36 (58%) to 1/5 (20%). There were no adverse outcomes observed in the period before or after the intervention. We demonstrate a simple, cost-effective quality improvement project using fundamental human factors principles. This initiative successfully reduced the number of term admissions for hypoglycaemia over 4 years.