562 - Improving Pulse Oximetry Efficiency in Neonatal Resuscitation: A Quality Improvement Initiative

Publication Number: 3543.562

Breana Cocelli, Cooper Medical School of Rowan University, Pemberton, NJ, United States; Adnan AhmedUddin, The Children's Regional Hospital at Cooper, Dayton, NJ, United States; Ebby Varughese, Cooper Medical School of Rowan University, Mullica Hill, NJ, United States; Vishwanath Bhat, Cooper University Hospital, Camden, NJ, United States; Sarra Bae, The Children's Regional Hospital at Cooper, Camden, NJ, United States; Alla Kushnir, Cooper Medical School of Rowan University, Camden, NJ, United States

Background: The transition from intrauterine to extrauterine life requires rapid respiratory and cardiovascular adaptation, with approximately 5-10% of infants requiring some degree of respiratory support. Pulse oximetry is an essential component of neonatal resuscitation, providing real-time monitoring of heart rate and oxygen saturation; however, its utility is often limited by workflow inefficiencies and signal acquisition delays.

Objective: To evaluate these obstacles, a quality improvement (QI) initiative was implemented at an urban academic hospital with the aim of enhancing pulse oximetry efficiency to improve achievement of 5-minute SpO2 targets defined by Neonatal Resuscitation Program guidelines.

Design/Methods: Prospective data collection began in February 2025 and included all deliveries requiring respiratory support. Multiple Plan-Do-Study-Act (PDSA) cycles were conducted throughout the year, the first of which involved multi-departmental education of NICU nurses, respiratory therapy (RT) staff, pediatric residents and pediatric and neonatal attendings. Further PDSA cycles included standardizing specific pulse oximeter probe placement, and the last PDSA altered policy to require immediate Pulse Ox application for infants < 35 weeks' gestation. Data were analyzed across three time periods: before June 1 (Era 1), June 1-September 3 (Era 2= PDSA Cycle 1-3), and after September 3, 2025 (Era 3 = PDSA Cycle 4-5). Outcomes included time to probe placement and time to consistent and reliable signal acquisition.

Results: A total of 102 neonates were included with a mean birthweight (BW) of 2589 grams and gestational age (GA) of 35.5 weeks. Time from birth to probe placement decreased by 25% from Era 1 (150.8 ± 105.5 s) to Era 2(113.0 ± 95.1 s) and by 10% in Era 3 (136.4 ± 96.5 s) (p=0.013). Time from placement to reliable signal acquisition decreased by 50% (101.8 ± 128.7 s) from Era1 to Era 2 (49.7 ± 55.1 s) and by 42% in Era 3 (59.0 ± 63.1 s) (p=0.28). No significant difference was detected in mean time to signal acquisition between infants who achieved (67.1 ± 77.0s) and did not achieve (91.9 s ± 125.8) achieve 5-minute SpO2 targets (p=0.33).

Conclusion(s): While decreases in signal pick-up from pulse ox placement were not statistically significant, there was a 50% reduction in time until consistent reading. This reduced delays in care and resuscitation. These results support continued PDSA cycles to refine pulse oximetry workflow and enhance neonatal resuscitation efficiency.

Figure 1
Duration (in seconds) between pulse oximeter probe placement and reliable signal acquisition by date, divided by PDSA cycle.