P2.F112: Applying the Science of Quality Improvement to Navigate Challenges in Newborn Screening Initiatives in the Post-COVID Era

Purpose/Objectives: Timeliness is a critical factor influencing early detection and management of metabolic conditions with the newborn screening (NBS) process. Optimization of this process can have a long-lasting impact on neonates and their families. In 2019, New York State’s Newborn Screening Program (NSP) in Albany implemented a 24-36 hour window to obtain blood specimens and a 48-hour transit time to receive them at the NSP lab. The COVID pandemic and an unprecedented staff turnover faced by the largest public health system in the country, New York City Health and Hospitals (NYCH+H), led to the reallocation of resources away from essential training and standard processes. In 2023, NYCH+H/Jacobi identified systemic shortcomings in NSP quality metrics disproportionately impacting NICU patients. We began testing local solutions to improve the number of unsuitable specimens from the NICU and the sample transit time to Albany. Global

Aim: To ensure good outcomes by facilitating timely diagnoses for all newborns with inherited metabolic disorders. SMART

Aims: a) To achieve 20% increase in samples received at NSP within 2 days by June 2024, and b) To decrease need for repeat screens due to unsuitable specimens to 2% by December 2024.

Design/Methods: Our multidisciplinary team members from the NICU, newborn nursery, phlebotomy, information technology, labor and delivery, primary care pediatrics, and newborn screen coordinators received real-time training in QI methodology. We used process maps, cause-effect diagrams, and Pareto charts to assess current state. The predictable schedule of the second test deemed it most suitable for PDSA trials. Monthly transit time is provided by NSP. The key drivers identified were: developing defined processes, staff trained in specific skills, optimal environment for specimen collection and preparation, and routine updates from NSP communicated to all stakeholders.
PDSA#1: Adjusting collection time of 2nd sample to ensure timely shipping - from Day of Life (DOL) 3-5 to DOL 3: first morning draw and subsequently to the specific time DOL 3: 1am. PDSA#2: Establishing a standard process for obtaining and preparing specimens, including designated racks for drying. PDSA#3: Developing an interdepartmental consensus protocol.
PDSA#4: Standardizing didactic and practical training covering all departments.

Results: Median collection time for 284 second samples improved from 12:23 pm to 6:22am during 2022-2023 (Fig 1).
Transit time of samples received in < 2 days improved from 833/1436 (58%) in 2022 to 1237/1923 (64%) in 2023 (Fig 1).
Unsuitable NICU samples decreased from 35/509 (7%) to 34/799 (1%) by January 2024 (Fig 2).

Conclusion/Discussion: QI education engaged and inspired the next generation of frontline staff. Support for their improvement ideas empowered them to take risks that resulted in tangible successes in NBS quality metrics. A safe space with agency is needed to pave the way toward a culture of improvement in the post-COVID era.