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Quality improvement programme to increase the rate of deferred cord clamping at preterm birth using the Lifestart
Emily Suzanne Hoyle1, Sunaya Hirani1, Sally Ogden1
1Neonatal Unit, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK.
Insights
The Lifestart trolley
Area of Science:
- Neonatal Resuscitation
- Quality Improvement in Healthcare
- Perinatal Medicine
Background:
- Premature infants (<32 weeks' gestation) require specialized resuscitation and stabilization.
- Intact umbilical cord management, including deferred cord clamping (DCC), is crucial for preterm neonates.
- The Lifestart trolley is designed to facilitate resuscitation with an intact umbilical cord.
Purpose of the Study:
- To enhance the documented utilization of the Lifestart trolley for preterm infant resuscitation.
- To improve the rate of deferred cord clamping (DCC) in eligible preterm infants.
- To identify and address barriers to Lifestart trolley use and DCC compliance.
Main Methods:
- A 13-month quality improvement initiative using Plan, Do, Study, Act (PDSA) cycles.
- Review of 113 consecutive preterm deliveries to assess Lifestart trolley use and DCC adherence.
- Analysis of non-compliance, root cause identification, and implementation of targeted interventions.
- Dissemination of data and lessons learned through staff newsletters and graphical presentations.
Main Results:
- Documented Lifestart trolley use increased from 10% to 79% over the project period.
- Among eligible preterm infants, the DCC rate rose significantly from 17% to 92% (p<0.0001).
- 35% of preterm infants in the study were not eligible for DCC.
Conclusions:
- Regular PDSA cycles and enhanced staff education significantly improved Lifestart trolley use and DCC rates.
- The Lifestart trolley facilitates DCC, contributing to better neonatal care practices.
- Sustained compliance is supported by ongoing education and resources, such as instructional videos.
Aim:
To increase the documented use of the Lifestart trolley to allow premature infants' (<32 weeks' gestation) resuscitation and stabilisation with an intact umbilical cord at delivery.
Design:
A 13-month quality improvement programme from April 2018 to April 2019 was undertaken using Plan, Do, Study and Act (PDSA) cycles. Data were reviewed from 113 consecutive preterm (<32 weeks) deliveries to identify whether Lifestart was used and whether 2 min deferred cord clamping (DCC) occurred in eligible infants as per hospital policy. Episodes of non-compliance were analysed, causes established and interventions implemented to reduce similar future non-compliance. Data collected were presented graphically and included in alternate monthly newsletters to staff, which also included lessons learnt from the reviews of non-compliance.
Results:
Documented use of the Lifestart rose from 10% at the start of the project to 79% in the final month. Not all babies are eligible for DCC. Within this project, 40 (35%) of preterm infants were not eligible to receive DCC. Of those that were eligible, the rate of DCC increased from 17% in the first 3 months to 92% in the last 3 months of the project (p<0.0001).
Implications And Relevance:
By undertaking regular PDSA cycles and improving education surrounding importance of DCC, we have noted a significant improvement in the use of Lifestart, which in turn facilitates DCC.The learning from this project has been used to create an instructional video to help maintain the improved compliance rates.
