Improving Delayed Cord Clamping Across Tennessee Through a Statewide Quality Collaborative

The objective of this initiative was to increase the proportion of infants born in participating hospitals receiving the benefits of delayed cord clamping (DCC) for at least 60 seconds to a minimum of 90% for each facility.

In January 2022, a quality improvement (QI) initiative was launched across 5 pilot hospitals, later expanding to 22 additional hospitals in May 2022. The goal of the initiative was to ensure that all newborns at each facility experienced a delay of at least 60 seconds before umbilical cord clamping. Monthly data collection continued through June 2023, tracking the number of live births, the number of infants whose cords were clamped after 60 seconds, and race/ethnicity. Balancing measures, including the number of infants with a 5-minute appearance, pulse, grimace, activity, and respiration (Apgar) score of up to 3 and hypothermia (temperature of <36.5 °C), were recorded monthly. Structure and process measures critical for improving DCC rates were also identified and monitored.

At project completion, 61 642 out of 74 241 (83%) infants received a delay of at least 60 seconds in cord clamping. The aggregate baseline mean for DCC was 76%. Special cause variation (a favorable shift) was observed, resulting in an adjusted mean rate of 87% for DCC. The impact was consistent across both level I/II and level III/IV facilities.

This report highlights the successful implementation of DCC practices through the state's perinatal QI collaborative. Evidence-based QI initiatives can significantly enhance uptake of recommended practices and improve infant care during birth.