104 - Improving Timely Completion of Golden Hour Targets in the Neonatal Intensive Care Unit

Publication Number: 4102.104

Uduak Akpan, Brody School of Medicine at East Carolina University, Greenville,NC, NC, United States; Kayla Ausbon, Brody School of Medicine at East Carolina University, Washington, NC, United States; Lindsey N. Gieselman, James and Connie Maynard Children's Hospital at ECU Health, Kinston, NC, United States; Mandi Gray, Brody School of Medicine at East Carolina University, Vanceboro, NC, United States; Stephanie Smith, Brody School of Medicine at East Carolina University, Greenville, NC, United States; Shannon Moore, Brody School of Medicine at East Carolina University, Greenville, NC, United States; Meredith Paige. Chanas, Brody School of Medicine at East Carolina University, Winterville, NC, United States; Leeza Jones, ECU Health Medical Center, 3672 E Wilson Street, NC, United States

Background: The first hour of a neonate's life, the Golden Hour (GH) is a critical period with implications for short- and long-term outcomes. We noted sub-optimal processes in the GH among Very Preterm Neonates (VPT; < 32weeks of gestation) admitted to our NICU

Objective: To improve neonatal outcomes via the GH (first hour after NICU admission), in VPT neonates born at our institution and admitted to the NICU, over 3years. Specific aims were to:
1. Achieve 80% normal admission temperature rate (36.5-37.5C)
2. Achieve 80% bedside glucose measurement rate within the GH
3. Achieve 40% antibiotic administration rate within the GH

Design/Methods: We formed a multidisciplinary team in 2021, collected baseline data, developed 3 specific aims, designed measures for each aim, and implemented interventions over a series of Plan Do Study Act (PDSA) cycles. Key interventions for temperature management included delivery room (DR) temperature measurement, transport via a special shuttle and leveraging the electronic medical record to ensure interventions for abnormal DR temperatures (Oct 2021- July 2024). For glucose measurement, we targeted central line placement initiation within 20 minutes of admission and completion within 1 hour (Oct 2021 - Dec 2023); and for timely antibiotic administration, we scheduled x-rays with admission orders to ensure timely confirmation of line position (Apr 2024). We collected and analyzed our data initially using mini audits of patients in cohorts consisting of 10 patients per quarter, and subsequently monthly, starting in Jan 2023. We tracked measures using statistical process control charts.

Outcome measures:
Percentage of neonates with normal admission temperature
Percentage of neonates with bedside glucose check within the GH
Percentage of neonates with antibiotics administered within 70 minutes of admission

Process measures:
Percentage of neonates with temperature measured in the DR
Percentage of central lines initiated within 20 minutes of admission
Percentage of central lines completed within the GH
Percentage of x-rays scheduled with admission orders

Balancing measures
Percentage of neonates with elevated temperature (>37.5C) after completion of line insertion

Results: Normal admission temperatures increased to 83% and glucose checks on admission increased to 88%, Antibiotic administration remained at 24%. Central line initiation and completion rates showed center line changes, while other process measures and the balancing measure remain unchanged.

Conclusion(s): We have mostly achieved our project goals and evaluation of our processes suggest progress toward the last goal.

Key Driver Diagram
Chart showing key drivers and interventions

Outcome Measures
Outcome Measures.pdfChart showing outcome measures and PDSA cycles

Process measures
Process Measures.pdfChart showing process measures