135 - Golden Hour: A Golden Opportunity to Improve Early Care in Very Preterm Infants

Publication Number: 3129.135

Jocelyn Ou, Emory/Children's Healthcare of Atlanta, Atlanta, GA, United States; Sydney Jones, Emory University School of Medicine, Chattahoochee Hills, GA, United States; Allison Vale, Emory University School of Medicine, Atlanta, GA, United States; Caitlin Pugh, Children's Healthcare of Atlanta, Atlanta, GA, United States; Shenell Reynolds, Emory University School of Medicine, Frisco, TX, United States; Lauren H. Crepeau, Emory University School of Medicine, Marietta, GA, United States; Katherine Wong, Emory Healthcare, Atlanta, GA, United States; Steven Pitts, Emory University School of Medicine, Atlanta, GA, United States; Danielle Goldstein, Emory University School of Medicine, Decatur, GA, United States; Summer Elshenawy, Emory University and Children’s Healthcare of Atlanta, Atlanta, GA, United States; Patricia Denning, Emory University School of Medicine, Atlanta, GA, United States; Ravi M. Patel, Children's Healthcare of Atlanta and Emory University, Atlanta, GA, United States; Anthony J. Piazza, Emory University/Children's Healthcare of Atlanta, Atlanta, GA, United States

Background: In neonatology, the efficient completion of procedures and the administration of medications required to resuscitate and stabilize a very preterm neonate in the hour following delivery is known as the Golden Hour. Optimizing immediate postnatal management significantly improves short- and long-term outcomes, which include reducing mortality, intraventricular hemorrhage (IVH), retinopathy of prematurity and bronchopulmonary dysplasia.

Objective: We aimed to use quality improvement methodology to decrease the mean time required to complete Golden Hour admission procedures from 138 minutes to 120 minutes within six months for neonates < 32 weeks or < 1500g born at an urban academic 48-bed level III NICU.

Design/Methods: This QI initiative began in September 2023 and included neonates born at < 32 weeks or < 1500g. In April 2025, a team pre-admission huddle and access process map were utilized in the first PDSA cycle. The primary measure was time to completion of a Golden Hour admission, which includes providing respiratory support, administering surfactant, intravenous fluids (IVF) and antibiotics, and obtaining central access and labs. The outcome measures were incidence of IVH or mortality and percentage of neonates with euglycemia, defined as a glucose level > 40. Process measures focused on time to start IVF, percentage of successful peripheral intravenous (PIV) catheters placed in the delivery room (DR), and percentage of pre-admission huddles completed. Balancing measures included time in the DR, rate of PIV infiltrates and central line-associated bloodstream infections.

Results: We tracked time-based data for 210 infants with a mean gestational age of 28 + 4/7 and mean birth weight of 1066g. Over seven months, we observed special cause variation and a decrease in time to Golden Hour completion from a baseline of 138 minutes to 84 minutes at most recent assessment. IVF start time decreased from 51 minutes at baseline to 32 minutes and euglycemia increased from 56% at baseline to 64% on last assessment. During the seven-month action period, PIVs were successfully placed in the DR 75% of the time and did not significantly increase time spent in the DR.

Conclusion(s): Initial improvements in decreasing the time to golden hour admission completion were shown after implementing a multidisciplinary pre-admission huddle and access process map, which established team roles and a shared mental model to improve team dynamics and communication. Starting a PIV in the DR was associated with decreasing IVF start time without increasing time spent in the DR.

Time of Life at Bed Closure
Control chart of average time of life at bed closure