Timely care for tiny lives: quality improvement for golden hour management bundle

Preterm babies face a high risk of hypothermia, respiratory distress and hypoglycaemia soon after birth. The golden hour-the first 60 min of life-has been shown to improve outcomes with evidence-based, timely interventions. An audit in our neonatal intensive care unit (NICU) in central India showed that only 7.7% of preterms received the golden hour management bundle (GHMB).

This quasi-experimental study was conducted between May 2023 and May 2025 in inborn preterms <34 weeks. A multidisciplinary team used process mining and root cause analysis to identify delays in GHMB. Multiple plan-do-study-act (PDSA) cycles were conducted, including revised delivery room transfer policies, dedicated resident role allocation, thermal care practices, ventilator and consumables buffer stock and preprepared intravenous cannula trays. Data were collected prospectively and analysed using time-motion analysis and statistical process control charts.

A total of 294 preterms were studied. The median time to complete GHMB decreased from 107 min at baseline to 55 min in the sustainability phase (p<0.001). The percentage of preterms receiving GHMB rose from 7.7% to 71.7%. The rate of moderate hypothermia at admission decreased from 100% to 12.1%. Timely intravenous fluid administration improved from 12.5% to 80.4%, and medications within the first hour increased from 4.1% to 71%.

Process mining helped identify and reduce rate-limiting steps as well as reorganise and reassign tasks, thereby improving the proportion of preterms receiving GHMB.