722 - "I've Got A Golden Ticket": A NICU Quality Improvement Initiative

Poster Number: 722
Publication Number: 722.342

Meriam J. Avades, BronxCare Health System, New York, NY, United States; Sagar R. Bhandary, Icahn School of Medicine at Mount Sinai, Edgewater, NJ, United States; Serena A. Harris, Bronx Care Hospital Systems, Bronx, NY, United States; Patrick Sodeke, Bronxcare Health system, Bronx, NY, United States; Barbara K. Russell, The Icahn School of Medicine at Mt Sinai, New York, NY, United States

Background:
The golden hour refers to the first hour of an infant’s life, when a critical transition period takes place. Very low birth weight (VLBW) infants (< 1500 grams) are especially vulnerable to their environment. The concept of the golden hour includes practicing all evidence-based interventions within the first 60 minutes of life, leading to better outcomes. We designed an evidence-based golden ticket to be used for all VLBW infants with a goal to stabilize and perform admission procedures within one hour of birth at the BronxCare Health System (BCHS) Level III neonatal intensive care unit (NICU).


Objective: Our global aim is to improve outcomes related to hypothermia, chronic lung disease, hypoglycemia, and sepsis for VLBW infants. The SMART aim is for the BCHS NICU to have a 50% improvement in the time to stabilization and admission of VLBW infants, specifically in the time to administration of surfactant, intravenous (IV) fluids, and antibiotics, when indicated, by February 2023.

Design/Methods: This quality improvement project follows a stepwise process: Plan, Do, Study, Act (PDSA). A retrospective chart review of data for 90 VLBW infants born between January 2020 and December 2021 was performed. It showed the average time to stabilization with surfactant, fluids, and antibiotics ranged between 2-6 hours. The data was presented to the NICU multidisciplinary team and the golden ticket was introduced. A checklist was created to be used for all VLBW infants born in our institution. Educational sessions were held for nursing, respiratory therapy, and NICU staff. The golden ticket officially launched in February 2022 and infants less than 1500 grams were identified as golden ticket babies. Barriers, such as timely chest x-ray after line placement and clinical, rather than radiographic, confirmation of endotracheal intubation prior to surfactant administration, were addressed. Statistical process control charts were used to display and analyze data over time.

Results: After introducing the golden ticket, we noted a decreased stabilization time of the 20 VLBW infants born between February and November 2022. The mean time to surfactant administration decreased from 2 hours, 30 minutes to 1 hour, 7 minutes (Figure 1), achieving the SMART aim. The mean time to administration of fluids and antibiotics (Figure 2) was reduced but remained close to 2 hours after birth.

Conclusion(s): The introduction of the golden ticket initiative in our NICU decreased the stabilization time of VLBW infants. The goal of the next PDSA cycle is to identify additional barriers leading to a delay in fluid and antibiotic administration.