Using quality-improvement methods to reduce variation in surfactant administration.
BACKGROUND
Respiratory distress syndrome and chronic lung disease are prevalent disorders in extremely low-birth-weight infants. Evidence demonstrates that timely surfactant administration improves respiratory outcomes.


OBJECTIVE
To assess whether basic quality-improvement methods can reduce the time to initial surfactant dose for premature infants.


METHODS
The study was conducted in a 48-bed neonatal intensive care unit (NICU) within a midsize academic centre. The authors included infants less than 27 weeks born from May 2007 to November 2007. Prior to the intervention, we obtained baseline data on the timing of initial surfactant dose. The intervention was designed using a series of Plan-Do-Study-Act cycles. The authors changed the process of surfactant administration to include administration of surfactant in the delivery room and a respiratory therapist on the delivery room team. The primary outcome measures were percentage of eligible infants who received surfactant in the delivery room and minutes after delivery at which the initial dose of surfactant was administered.


RESULTS
After the authors changed the surfactant administration process, 20/21 (95%) of eligible infants received surfactant in the delivery room. The authors decreased the time after delivery of initial surfactant dose from a mean of 26 min to 10.2 min (p=0.0004). The variation in timing of the initial surfactant dose also decreased.


CONCLUSIONS
The authors demonstrated that quality-improvement methods can be used to improve the timeliness and reduce variation in timing of surfactant administration within a NICU. Future studies should assess whether these results can be replicated in a variety of NICU settings.
Bookman
Laurel
L
Division of Neonatology, Cincinnati Children's Hospital, MLC 7009, 3333 Burnet Avenue, Cincinnati, OH 45209, USA. laurelmed1@yahoo.com
Troy
Rachel
R
McCaffrey
Martin
M
Randolph
Greg
G
D000046:Academic Medical Centers; D006801:Humans; D007363:Intensive Care Units, Neonatal; D009657:North Carolina; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods*; D013501:Surface-Active Agents / Q000008:administration & dosage*
D013501:Surface-Active Agents