NASCAR pit-stop model improves delivery room and admission efficiency and outcomes for infants <27 weeks' gestation

Brooke D Vergales, Elisabeth J Dwyer, Sarah M Wilson, Evelyn A Nicholson, Rachel C Nauman, Li Jin, Robert A Sinkin, David A Kaufman
Resuscitation 2015, 92: 7-13

AIM: To evaluate a new process based on teamwork in a manner similar to the race car pit stop on organization and efficiency during the "Golden Hours" for extremely preterm infants.

METHODS: A team designed an improved process focused on checklists, preparation, assigning roles, and best practices, for the care of infants <27 weeks' gestation in the delivery room (DR) through admission to the neonatal intensive care unit (NICU). Clinical outcomes 2 years before and after implementation were analyzed. A survey was administered to NICU staff prior to and 14 months after implementation. The survey assessed organization and efficiency in the DR and during the admission process of the target population.

RESULTS: There were 62 inborn infants prior to and 90 infants after implementation with overall survival of 90.3% and 86.6%, respectively (p = 0.61). Infants were more stable on admission with a mean arterial blood pressure equal to or greater than their gestational age in the post intervention group compared to the pre-cohort (76% vs 57%, p = 0.02) and discharged home at a lower mean postmenstrual age (39.0 ± 2.2 vs 40.1 ± 3.5 weeks, p = 0.04) The survey demonstrated improvement in assessment of roles being clearly defined in the DR and in the organization and the efficiency both in the DR and during the NICU admission (p < 0.05).

CONCLUSIONS: A systematic approach to the care of the <27 weeks' gestation neonate increased staff perception of improved organization and efficiency in the DR through admission processes and improved outcomes.

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