119 - Implementation of “Surfactant Silver Hour” to decrease the time to surfactant administration in early preterm infants (<32 weeks)- A Quality Improvement Project

Publication Number: 4117.119

Genesis T. Mancha, Loyola University Chicago Stritch School of Medicine, Chicago, IL, United States; Laura E.. Sciaraffa, Loyola University Chicago Stritch School of Medicine, Itasca, IL, United States; Lindsey Young, Loyola University Chicago Stritch School of Medicine, Addison, IL, United States; Sachin Amin, Loyola University Chicago Stritch School of Medicine, Maywood, IL, United States; Astrid H. Leon Silva, Loyola University Chicago Stritch School of Medicine, Maywood, IL, United States; Kirsten Sorum, Advocate Children's Hospital - Oak Lawn, Oak park, IL, United States

Background: Timely surfactant administration is essential for the treatment of respiratory distress syndrome (RDS). There is a significant variation in the average time to surfactant administration. Current evidence demonstrates that early surfactant administration within 2 hours of birth leads to a reduction in neonatal morbidity and mortality.

Objective: To decrease the time of surfactant administration in cases of infants with RDS to within 2 hours after birth.

Design/Methods: We implemented a "Surfactant Silver Hour" quality initiative targeting early administration of surfactant in very preterm infants within 2 hours after birth. This initiative included staff education for our NICU team (physicians, nurses and respiratory therapists) to reinforce the importance of timely early administration of surfactant. We designed and implemented a surfactant administration guideline, algorithm, and debriefing form to monitor the time to surfactant administration. This helped the NICU team to streamline clinical workflows and to expedite decision regarding surfactant treatment. Baseline pre-implementation data was obtained through our VON (Vermont Oxford Network) Database and compared to 9 months of post implementation data.

Results: In a 9-month period after implementation of the quality project, 10 out of 14 (71%) neonates received surfactant within two hours after birth. This was an increase from a baseline rate of 39%. The average time to surfactant administration post implementation was 102 minutes.

Conclusion(s): Implementation of "Surfactant Silver Hour" quality project led to a substantial improvement in time to surfactant administration in early preterm infants.

Pre and Post Surfactant Timing
Pre and Post Implementation Surfactant Timing

Post-Implementation Average Surfactant timing
Average time to surfactant following implementation of "Surfactant Silver Hour" Quality Improvement Project.

LUMC NICU Surfactant Algorithm
LUMC NICU Surfactant Decision Algorithm