777 - Golden Hour - 60 Minutes to Shine: A Quality Improvement Initiative to Improve Initial Stabilization Time in Tiny Babies at an Urban Level III NICU

Publication Number: 2758.777

Dhwani Oza, University of Texas at Austin Dell Medical School, Austin, TX, United States; Juan Gallegos, Dell Children's Medical Center of Central Texas, Austin, TX, United States; Sheena John, Dell Children's Medical Center of Central Texas, Austin, TX, United States; April Miller, Dell Children's Medical Center of Central Texas, Austin, TX, United States; Jimmy Ferreras, Ascension seton medical center austin, KYLE, TX, United States; Davika Reid-Bell, The University of Texas at Austin, Austin, TX, United States; Leah B. Staines, University of Texas at Austin Dell Medical School, Dripping Springs, TX, United States

Background: Effective stabilization of extremely premature infants during the "Golden Hour" (the first hour after birth) is crucial for improving both short- and long-term outcomes that influence neonatal morbidity and mortality. At our Level III NICU, baseline median time to "top-down" (end of stabilization) was 118 minutes for babies < 29 weeks gestation or < 1,000g, highlighting an opportunity to streamline care for this high-risk population.

Objective: Reduce the median top-down time from a baseline of 118 minutes (June - August 2024) to 90 minutes for in-born infants < 29 weeks or < 1,000g by August 2025.

Outcome measures: Top-down time, severe intraventricular hemorrhage (IVH).
Process measures: Prebrief/debrief completion, time to IV fluid initiation, antibiotic administration, normothermia, euglycemia, and admission SpO2.
Balancing measure: Umbilical venous catheters (UVC) related bloodstream infections.

Design/Methods: Guided by Kotter's 8-Step Change Model, we established a multiprofessional coalition to foster staff engagement and a culture of sustained, evidence-based practice change. Existing research has identified risks associated with prolonged stabilization, and our baseline data revealed extended stabilization times within our own setting-together establishing a shared sense of urgency among stakeholders. Fishbone and key driver (see Figure 1) diagrams identified barriers and opportunities, forming the foundation for project planning. Interventions were implemented and refined through iterative Plan-Do-Study-Act cycles. Regular communication and team meetings emphasized outcomes and empowered participation. Barriers were addressed through standardized prebrief/debrief checklists, visual cues, role assignments (see Figure 2), updated equipment, and simulation-based workflow testing. Early successes were shared to build momentum, and feedback loops informed subsequent cycles.

Results: Following sequential interventions, including standardized roles, checklists, simulations, and education, median top-down time decreased from 118 to 75 minutes. Concurrently, severe IVH on first head ultrasound has declined, with only one case reported since the initiative began, reflecting improved team coordination, workflow efficiency, and neonatal outcomes (see Table 1).

Conclusion(s): The Golden Hour initiative improved stabilization efficiency, demonstrating that structured workflow and strong team communication enhance outcomes for high-risk infants. Future efforts will expand to top-down completion in the delivery room, metric feedback emails, and point-of-care ultrasound for UVC placement.

Key Driver Diagram
Organizes our SMART aim into primary and secondary drivers with multiple targeted interventions, serving as a roadmap for achieving timely and standardized stabilization.

Team Roles
To help a team by clearly defining each member's responsibilities, ensuring accountability, coordination, and clarity about who does what.

Top Down and Severe IVH Run Chart
A) Top Down Run Chart: Displays reduction of top-down time with key intervention time stamps. B) Percentage of Severe IVH Run Chart: Highlights the decline in severe IVH rates following the implementation of Golden Hour.