Promoting teamwork may improve infant care processes during delivery room management: Florida perinatal quality collaborative's approach

Abstract

Background: LOCAL PROBLEM: Inadequate understanding of compliance with standardized evidence-based DR management.

Interventions: Promote inter-professional teamwork and a bundle of interventions focusing on resuscitation team roles, equipment check, and debriefing using QI methodology. Optimize delivery room (DR) management to achieve 10-min SPO₂ targets, delayed-cord clamping (DCC), team role assignment and debriefings in >50% of deliveries, and achieve normothermia in >75% of infants.

Methods: Over 15 months (Epoch 1 to 5), nine Florida hospitals implemented a DR management plan for infants <31 weeks gestational age or <1500 g (N=814) using quality improvement methodology.

Results: There was increased compliance of DCC (36 to 66%), role assignment (53 to 98%), debriefing rates (33 to 76%) and having all seven pre-delivery preparedness components fulfilled (34 to 75%). There were no significant improvements in admission temperatures or SPO₂ targeting. When 7 vs 0 items of pre-delivery preparedness were completed, we saw improvements in thermoregulation (57% vs 72%), SPO₂ targeting (60% vs 78%) and DCC compliance (43 to 67%).

Conclusion: Promoting teamwork by increasing pre-delivery preparedness is associated with improvement of thermoregulation, SPO₂ targeting and DCC compliance.