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  • Quality Improvement Article
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Improving neonatal resuscitation in Tennessee: a large-scale, quality improvement project

Journal of Perinatology volume 39, pages 1676–1683 (2019)Cite this article

Subjects

Abstract

Objective

We report a statewide collaborative quality initiative to improve resuscitation and stabilization practices following introduction of the 6th edition of the Neonatal Resuscitation Program.

Methods

Participants drafted a consensus toolkit of interventions and corresponding measures. Hospital teams collected baseline data, and implemented changes using PDSA-cycles and statistical process control charts.

Results

Nine Tennessee NICUs submitted data on 3771 resuscitations. “Special cause” improvements were achieved and sustained for pre-resuscitation checklists (77–90%) and team briefings (80–92%). Time to intravenous access (50–42 min), glucose infusion initiation (73–60 min), and antibiotic dosing (113–98 min) were also significantly reduced. Teams were unable to meet new NRP oxygen saturation targets. Improvements in post-resuscitation debriefing were not sustained, while communication with parents declined significantly (68–60%).

Conclusion

Large-scale collaboration facilitated statewide implementation of new guidelines, while highlighting under-appreciated systems challenges among competing resource demands.

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Funding

The Tennessee Initiative for Perinatal Quality Care is funded by a Grant Contract with the State of Tennessee through the Tennessee Department of Health, and was supported by Federal funds from CFDA 93.778 through the Bureau of TennCare.

Author information

Authors and Affiliations

  1. The University of Tennessee Health Science Center, Memphis, TN, USA

    Ajay J. Talati

  2. Vanderbilt University School of Medicine, Nashville, TN, USA

    Theresa A. Scott, Brenda Barker & Peter H. Grubb

  3. Tennessee Initiative for Perinatal Quality Care Operations Team, Nashville, TN, USA

    Theresa A. Scott, Brenda Barker & Peter H. Grubb

  4. Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA

    Peter H. Grubb

  5. University of Utah School of Medicine, Salt Lake City, UT, USA

    Peter H. Grubb

  6. Primary Children’s Hospital, Intermountain Healthcare, Salt Lake City, UT, USA

    Peter H. Grubb

Authors
  1. Ajay J. Talati
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  2. Theresa A. Scott
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  4. Peter H. Grubb
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on behalf of the Tennessee Initiative for Perinatal Quality Care Golden Hour Project Team

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Correspondence to Ajay J. Talati.

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The authors declare that they have no conflict of interest.

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Talati, A.J., Scott, T.A., Barker, B. et al. Improving neonatal resuscitation in Tennessee: a large-scale, quality improvement project. J Perinatol 39, 1676–1683 (2019). https://doi.org/10.1038/s41372-019-0461-3

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