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Why the Delay? A Quality Improvement Initiative for Delayed Cord Clamping in Preterm Infants
Ahmad Mohamad1, Ana Navidad2, Lindsay Edwards2
1Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia.
Insights
Delayed cord clamping (DCC) significantly improved for preterm infants using quality improvement methods. This practice change was sustained, enhancing clinical care for vulnerable newborns.
Area of Science:
- Neonatal Medicine
- Clinical Quality Improvement
- Perinatal Care
Background:
- Delayed cord clamping (DCC) is recommended for preterm infants.
- Implementation of DCC as standard practice for preterm infants (≤34 weeks gestation) can be challenging.
- Quality improvement (QI) initiatives are effective in optimizing clinical practices.
Purpose of the Study:
- To enhance delayed cord clamping (DCC) rates for preterm infants.
- To establish DCC as routine care for preterm infants using quality improvement (QI) methodologies.
- To identify and address barriers to DCC implementation in a neonatal setting.
Main Methods:
- A multi-departmental QI initiative was implemented.
- Audits of DCC rates and cord clamping documentation were conducted before, during, and after the intervention.
- Data surveillance monitored the impact of QI interventions on DCC rates and admission hypothermia.
Main Results:
- DCC rates for preterm infants increased from a baseline of 12% to 70% post-intervention.
- Documentation of cord clamp time improved from 16% to 92.6%.
- Admission hypothermia decreased from 76% to 43.2%.
Conclusions:
- A structured QI approach and interdepartmental collaboration significantly improved DCC rates for preterm infants.
- The observed improvements in DCC rates were sustained over time.
- QI methods are crucial for establishing and maintaining best practices in neonatal care.
Aim:
To improve delayed cord clamping (DCC) rates for preterm infants (≤ 34 + 0 weeks' gestation) and establish DCC as standard practice using quality improvement (QI) methods.
Methods:
A multi-departmental initiative was undertaken. An audit of DCC for preterm infants born at or before 34 + 0 weeks was performed. Using this data and feedback from multidisciplinary staff meetings, barriers to DCC implementation were identified and targeted QI interventions were introduced. Ongoing data surveillance monitored the effects of these interventions.
Results:
DCC rates were evaluated for 862 preterm infants from January 2014 to August 2022. This QI project commenced in February 2018, with a detailed audit of 225 preterm infants across three time periods: epoch 1 (immediately prior to QI initiative), epoch 2 (QI implementation phase), and epoch 3 (immediate post-implementation surveillance). Inconsistent documentation of cord clamp time and admission hypothermia were identified as potential barriers to implementation of DCC. Over the course of the initiative, the documentation rate increased from 16% to 92.6%. Hypothermia at admission decreased from 76% in epoch 1 to 43.2% in epoch 3. The baseline rate of DCC was low in epoch 1 (12%), but improved to 70% in epoch 3, with this change sustained in ongoing DCC rate evaluation to August 2022.
Conclusions:
There has been a significant and sustained improvement in DCC for preterm infants at our centre. A structured approach to QI and collaboration between multiple departments were each integral in effecting this improvement in clinical care.
