Using quality-improvement methods to reduce variation in surfactant administration.

Area of Science:

• Neonatal care
• Quality improvement science
• Respiratory medicine

Background:

• Respiratory distress syndrome and chronic lung disease are common in extremely low-birth-weight infants.
• Timely surfactant administration is crucial for improving respiratory outcomes in these vulnerable infants.

Purpose of the Study:

• To evaluate the effectiveness of basic quality improvement methods in reducing the time to initial surfactant dose for premature infants.
• To assess the impact of process changes on surfactant delivery timeliness.

Main Methods:

• The study utilized Plan-Do-Study-Act cycles in a 48-bed neonatal intensive care unit (NICU).
• Intervention involved surfactant administration in the delivery room with a dedicated respiratory therapist.
• Data collected on infants born less than 27 weeks gestation.

Main Results:

• Surfactant was administered in the delivery room for 95% of eligible infants post-intervention.
• The mean time to initial surfactant dose decreased from 26 minutes to 10.2 minutes (p=0.0004).
• Variation in the timing of surfactant administration was also reduced.

Conclusions:

• Quality improvement initiatives can effectively enhance the timeliness of surfactant administration in NICUs.
• These methods successfully reduced variability in treatment timing for premature infants.
• Further research is recommended to validate these findings across diverse NICU settings.