Using quality improvement to optimize neonatal transport team process metrics for critical transfers

Area of Science:

• Neonatal intensive care
• Healthcare quality improvement
• Patient transport logistics

Background:

• Timely neonatal transport is critical for critically ill infants.
• Identifying modifiable factors can improve transport efficiency and patient safety.
• A quality improvement (QI) initiative targeted mobilization time (MT), ambulance departure time (ADT), and vital sign documentation.

Purpose of the Study:

• To achieve ≥75% compliance with MT < 30 minutes.
• To achieve ≥75% compliance with ADT < 10 minutes.
• To achieve complete vital sign documentation during transport.

Main Methods:

• A QI project was conducted in a Level III NICU from January 2018 to August 2024.
• Iterative Plan-Do-Study-Act cycles guided the initiative, using the Systems Engineering Initiative for Patient Safety (SEIPS) framework.
• Multiple interventions were implemented to improve transport processes.

Main Results:

• 470 neonatal transports were analyzed.
• Statistical process control showed common cause variation in MT and ADT, with no sustained improvement due to external system stressors.
• Complete vital sign documentation demonstrated special cause variation and sustained improvement from March-April 2020, despite later declines.

Conclusions:

• QI interventions successfully improved vital sign documentation reliability.
• Consistent reductions in MT and ADT were not achieved.
• Sustained improvement in neonatal transport requires ongoing education, iterative refinement, and adaptability to external system pressures.