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Updated: Apr 26, 2026
Transcutaneous Microcirculatory Imaging in Preterm Neonates
Published on: December 31, 2015
Using quality improvement to optimize neonatal transport team process metrics for critical transfers
Javed Mannan1, Lindsey Simoncini2,3, Tyler J Allcroft4
1Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, USA. Javed.Mannan@umassmemorial.org.
Insights
Quality improvement efforts enhanced vital sign documentation during neonatal transport but did not consistently shorten mobilization or ambulance departure times. Improving transport efficiency requires adaptable systems addressing external pressures.
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.
Background And Objectives:
Timely neonatal transport is essential for the care of critically ill infants. Identifying modifiable factors influencing transport mobilization time (MT) may improve efficiency and patient safety. This quality improvement (QI) initiative aimed to achieve ≥75% compliance with MT < 30 minutes, ambulance departure time (ADT) < 10 minutes, and complete vital sign documentation during transport.
Methods:
We conducted a QI project in a Level III neonatal intensive care unit from January 2018 to August 2024 using iterative Plan-Do-Study-Act cycles guided by the Systems Engineering Initiative for Patient Safety framework. Multiple interventions were implemented.
Results:
A total of 470 neonatal transports were analyzed. Statistical process control demonstrated common cause variation in MT and ADT, with no sustained improvement over time; performance was influenced by external system stressors. In contrast, complete vital sign documentation showed special cause variation with sustained improvement beginning in March-April 2020. Although documentation declined later, overall compliance improved across the project period.
Conclusion:
QI interventions improved documentation reliability but did not consistently reduce MT or ADT. Sustained improvement in neonatal transport performance requires ongoing education, iterative refinement, and adaptability to external system pressures.
Impact:
A structured quality improvement initiative improved neonatal transport vital sign documentation but did not produce sustained reductions in mobilization or ambulance departure times Transport timing metrics were strongly influenced by external system stressors as well as internal process changes This study adds long term real world data from a Level III NICU evaluating neonatal transport performance over six years Use of the SEIPS framework and longitudinal SPC analysis differentiates internal process reliability from external system constraints The findings highlight the need for adaptable, resilient neonatal transport systems.
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