O2111: Going for Gold! QI project implementing Golden Hour+ initiative in neonates born < 30 weeks gestational age at a Level 4 NICU

Purpose/Objectives: Prompt care and stabilization has been shown to reduce morbidity and mortality in preterm infants. These neonates require numerous interventions including maintaining thermoregulation, respiratory management, establishing intravascular access, administering intravenous fluids, and initiating antibiotics when indicated. The sooner these components are completed, the better the immediate and long-term outcomes are. Preliminary data from January to August 2022 for our NICU demonstrated a lack of standardization in the initial stabilization of infants < 30 weeks GA across all teams in our level 4 NICU, reflecting an inconsistent pattern of achieving Golden Hour. To improve timely management of this vulnerable population, we created our Golden Hour QI initiative which we adjusted over time from 60 minutes to 90 minutes to better account for the initial 20-30 minute stabilization time at delivery on a different floor & transport time to the NICU, thus changing the name to Golden Hour plus (+) QI initiative.

Design/Methods: A multidisciplinary team (NICU Medical Director, Neonatology Fellow, Nurse educators, Managers, Nurses, Advanced Practice Practitioners, Clinical Pharmacist, and Respiratory Team manager) was created and met every two weeks to finalize components of Golden Hour+, standardize data collection, evaluate workflows, and create a key driver diagram (Fig 1A). We created a Golden hour+ Infographic poster (Fig 1B) and did extensive education for provider, nursing and respiratory teams in November 2022. We tracked data every two weeks and discussed strategies with group and individual feedback to teams to improve adherence to the protocol. Our process measures included achieving all of the following 5 components in 90 minutes from birth: achieving temperature ≥36.5℃, initiating 1st antibiotic dose, infusing IV fluids, placing peripheral IV/umbilical lines, and giving surfactant if indicated. Multiple PDSA cycles were implemented as data was reviewed.

Results: We reviewed data from January 2022 to December 2023 (n=147). There were 68% singleton deliveries and the rest were twins or triplets with an average GA of 26.5 weeks. Successful shift to achieving Golden Hour+ over 20% was noted upon monthly review, as noted on the control chart (Fig 2A). We also improved our median times to achieve the completion of Golden Hour+ components and decreased our overall max times as noted on the run charts (Fig 2B).

Conclusion/Discussion: Implementation of the Golden Hour+ initiative has improved our baseline achievement and surpassed our goal of 20%. Improved time to achieve: Surfactant administration by 54%, from median 51 min - 23.5 min; IVF initiation time by 44%, from median 117.5 min - 66 min; Antibiotics administration by 43%, from median 129 min - 74 min; and PIV/Umbilical line access by 25%, from median 65 min - 49 min. We plan to increase the goal to 50% for 2024 and evaluate effects on long term outcomes.