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Reducing Golden Hour Admission Times for Extremely Preterm Infants: An Improvement Science Initiative.

Nicholas M Heitkamp, Hannah Fox, Megan Elliott

    American Journal of Perinatology
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    This study significantly reduced the critical Golden Hour admission time for extremely preterm infants by 50%, from 117 to 59 minutes. This quality improvement initiative improved infant stabilization and care in the neonatal intensive care unit (NICU).

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    Area of Science:

    • Neonatal Medicine
    • Quality Improvement in Healthcare
    • Perinatal Care

    Background:

    • The Golden Hour is a critical period for extremely preterm infants (<28 weeks' gestation), where timely stabilization can prevent severe morbidities like intraventricular hemorrhage and bronchopulmonary dysplasia.
    • University of Virginia data revealed average Golden Hour admission times of 117 minutes for these infants, indicating a substantial need for process optimization.

    Purpose of the Study:

    • To implement a quality improvement initiative aimed at reducing the Golden Hour admission time for infants <28 weeks' gestation by 25% (to ≤87 minutes) within one year.
    • To enhance the efficiency and stability of care delivery during the critical first hour of life for extremely preterm neonates.

    Main Methods:

    • Utilized the Institution for Healthcare Improvement (IHI) methodology, employing two Plan-Do-Study-Act (PDSA) cycles to address delays.
    • PDSA 1 introduced a dedicated admission coordinator, standardized flowsheet, and visual timer; PDSA 2 focused on line-placement efficiency with auditory cues, team huddles, and earlier isolette closure.
    • Statistical Process Control (SPC) charts (XbarS, XmR) monitored admission time, process measures (glucose, IV dextrose, X-ray, surfactant), and balancing measures (temperature, glucose, severe IVH rates).

    Main Results:

    • Achieved a 50% reduction in average Golden Hour admission time, decreasing it from 117 to 59 minutes among 106 infants.
    • Improved the proportion of admissions meeting the target time (<87 minutes) from 8% to 100%, exceeding the study's aim.
    • Demonstrated decreased process variability and maintained stable balancing measures, indicating improved efficiency without compromising infant safety.

    Conclusions:

    • Two sequential PDSA cycles successfully and sustainably reduced Golden Hour admission time by 50% without adverse effects.
    • Structured team roles, real-time feedback mechanisms, and workflow redesign were key drivers for creating a more efficient and stable care process.
    • This systematic quality improvement initiative effectively optimized Golden Hour care and is potentially replicable in other Neonatal Intensive Care Units (NICUs).