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Improving the Rate of Delayed Cord Clamping in Preterm Infants: A Quality Improvement Project
Shannon Chan1, Meghan Duck2, Kate Frometa3
1Departments of Pediatrics.
Insights
Delayed cord clamping (DCC) significantly improved for preterm infants. This quality improvement project increased DCC rates by 63% in neonates under 34 weeks gestation, demonstrating sustained benefits.
Area of Science:
- Neonatal Medicine
- Perinatal Care
- Quality Improvement Science
Background:
- Delayed cord clamping (DCC) offers significant benefits for preterm infants.
- Improving DCC rates is crucial for optimizing neonatal outcomes.
- Existing protocols may not be consistently implemented in tertiary care settings.
Purpose of the Study:
- To increase the rate of delayed cord clamping (DCC) by 25% within 12 months for neonates born less than 34 weeks' gestation.
- To implement and evaluate targeted interventions to enhance DCC adherence.
- To assess the impact of interventions on process and balancing measures.
Main Methods:
- A multidisciplinary team utilized quality improvement methodology.
- Key drivers for DCC rates were investigated, leading to targeted interventions.
- Data were collected via chart review and a perinatal database, analyzed using control charts.
Main Results:
- The rate of DCC increased by 63%, from 40% to 65% (P <.001) in neonates <34 weeks' gestation.
- Sustained improvement in DCC rates was observed over an 18-month period.
- Process measures improved significantly without adverse changes in balancing measures.
Conclusions:
- Core quality improvement methodology and targeted interventions effectively increased DCC rates in early preterm infants.
- The study highlights the successful implementation of a multidisciplinary approach to enhance neonatal care practices.
- Sustained improvements suggest the interventions are robust and beneficial for the target population.
Objective:
Delayed cord clamping (DCC) provides many benefits for preterm infants. The aim of this quality improvement project was to increase the rate of DCC by 25% within 12 months for neonates <34 weeks' gestation born at a tertiary care hospital.
Method:
A multidisciplinary team investigated key drivers and developed targeted interventions to improve DCC rates. The primary outcome measure was the rate of DCC for infants <34 weeks' gestation. Process measures were adherence to the DCC protocol and the rate of births with an experienced neonatology provider present at the bedside. Balancing measures included the degree of neonatal resuscitation, initial infant temperature, and maternal blood loss. Data were collected from chart review and a perinatal research database and then analyzed on control charts. The preintervention period was from July 2019 to June 2020 and the postintervention period was from July 2020 to December 2021.
Results:
322 inborn neonates born at <34 weeks' met inclusion criteria (137 preintervention and 185 postintervention). The rate of DCC increased by 63%, from a baseline of 40% to 65% (P <.001), with sustained improvement over 18 months. Significant improvement occurred for all process measures without a significant change in balancing measures.
Conclusion:
Using core quality improvement methodology, a multidisciplinary team implemented a series of targeted interventions which was associated with an increased rate of DCC in early preterm infants.
