Using quality-improvement methods to reduce variation in surfactant administration

Respiratory distress syndrome and chronic lung disease are prevalent disorders in extremely low-birth-weight infants. Evidence demonstrates that timely surfactant administration improves respiratory outcomes.

To assess whether basic quality-improvement methods can reduce the time to initial surfactant dose for premature infants.

The study was conducted in a 48-bed neonatal intensive care unit (NICU) within a midsize academic centre. The authors included infants less than 27 weeks born from May 2007 to November 2007. Prior to the intervention, we obtained baseline data on the timing of initial surfactant dose. The intervention was designed using a series of Plan-Do-Study-Act cycles. The authors changed the process of surfactant administration to include administration of surfactant in the delivery room and a respiratory therapist on the delivery room team. The primary outcome measures were percentage of eligible infants who received surfactant in the delivery room and minutes after delivery at which the initial dose of surfactant was administered.

After the authors changed the surfactant administration process, 20/21 (95%) of eligible infants received surfactant in the delivery room. The authors decreased the time after delivery of initial surfactant dose from a mean of 26 min to 10.2 min (p=0.0004). The variation in timing of the initial surfactant dose also decreased.

The authors demonstrated that quality-improvement methods can be used to improve the timeliness and reduce variation in timing of surfactant administration within a NICU. Future studies should assess whether these results can be replicated in a variety of NICU settings.