Quality improvement initiative to impact Golden Hour timeliness using a dedicated delivery team.

OBJECTIVE: Golden Hour (GH) care impacts immediate and long-term outcomes for premature infants. We hypothesized that creation of a dedicated delivery team, the Stork Team, would improve delivery of GH care. METHODS: A GH quality improvement initiative was created for infants born at <32 weeks and implemented in July 2018. Data were collected from GH checklists and the electronic medical record. RESULTS: Following Stork Team implementation there was special cause variation noted in the minute of life (MOL) for administration of dextrose containing fluids and antibiotics. Dextrose containing fluid time improved from 111 to 67 MOL, with an increase in the percentage of patients receiving fluids by 60 MOL. Antibiotic administration improved from 180 to 82.5 MOL. GH checklist completion increased from 77% to 98% and time to isolette closure improved from 88 to 62 MOL. CONCLUSION: Implementation of the Stork Team was associated with improvements in timeliness of GH care.

Placental Transfusion, Timing of Plastic Wrap or Bag Placement, and Preterm Neonates.

OBJECTIVE: Compare delivery room practices and outcomes of infants born at less than 32 weeks' gestation or less than 1,500 g who have plastic wrap/bag placement simultaneously during placental transfusion to those receiving plastic wrap/bag placement sequentially following placental transfusion. STUDY DESIGN: Retrospective analysis of data from a multisite quality improvement initiative to refine stabilization procedures pertaining to placental transfusion and thermoregulation using a plastic wrap/bag. Delivery room practices and outcome data in 590 total cases receiving placental transfusion were controlled for propensity score matching and hospital of birth. RESULTS: The simultaneous and sequential groups were similar in demographic and most outcome metrics. The simultaneous group had longer duration of delayed cord clamping compared with the sequential group (42.3 ± 14.8 vs. 34.1 ± 10.3 seconds, p < 0.001), and fewer number of times cord milking was performed (0.41 ± 1.26 vs. 0.86 ± 1.92 seconds, p < 0.001). The time to initiate respiratory support was also significantly shorter in the simultaneous group (97.2 ± 100.6 vs. 125.2 ± 177.6 seconds, p = 0.02). The combined outcome of death or necrotizing enterocolitis in the simultaneous group was more frequent than in the sequential group (15.3 vs. 9.3%, p = 0.038); all other outcomes measured were similar. CONCLUSION: Timing of plastic wrap/bag placement during placental transfusion did affect duration of delayed cord clamping, number of times cord milking was performed, and time to initiate respiratory support in the delivery room but did not alter birth hospital outcomes or respiratory care practices other than the combined outcome of death or necrotizing enterocolitis. KEY POINTS: · Plastic bag placement during placental transfusion is effective in stabilization of preterms.. · Plastic bag placement after placental transfusion is effective in stabilization of preterms.. · Plastic bag placement during placental transfusion and risk of death or necrotizing enterocolitis needs additional study..

Simulation Education for Preterm Infant Delivery Room Management at Community Hospitals.

BACKGROUND: Preterm infants are at risk for hypothermia in the delivery room (DR). Hypothermia and community hospital delivery are factors associated with increased morbidities and mortality in preterm infants. Community hospital providers have less experience with preterm deliveries and thermoregulation methods in the DR. METHODS: Community hospital DR providers in Indiana completed a cognitive test evaluating preterm infant DR management. A simulation-based team assessment was evaluated by using a scoring tool. After debriefing, the simulation performance was repeated and rescored. Afterward, providers completed a cognitive knowledge posttest. Eleven to eighteen months later, sites were revisited with cognitive knowledge and team simulated scenarios reassessed. RESULTS: Twenty-five community hospitals with >400 multidisciplinary providers participated in the initial study visit. Average pre- and posttest scores were 48.8% and 94.1% respectively (P value <.001). Participants performed an average of 22.8 of 36 scoring items during a simulated preterm delivery including 4.4 of 8 thermoregulation related actions. Performance immediately improved in a statistically significant manner during the repeat scenario. When sites were revisited, participants performed an average of 26.7 of 36 scoring items including 6.1 of 8 thermoregulation actions during a simulated preterm delivery a statistically significant (P <.001) improvement from the initial visit. CONCLUSIONS: Simulation education regarding preterm infant DR management improved community providers immediate knowledge and skills and also follow-up performance at ∼1 year. In simulation, providers performed thermoregulation maneuvers more often and efficiently, critical to resuscitation because delays in thermoregulation can significantly adversely affect outcomes.