Resident University of Michigan Medical School Ann Arbor, Michigan, United States
Background: Infants with prenatally diagnosed surgical anomalies born at our integrated birth center/children’s hospital are delivered in the obstetric operating room (OR) to facilitate immediate access to our neonatal resuscitation area and NICU care. Some infants with surgical anomalies might not require immediate evaluation/stabilization and can be safely delivered in the gestational parent’s room, allowing for important infant/parent bonding time and reducing unnecessary use of ORs. Standardized language and processes to promote family centered care and judicious use of hospital resources without compromising safe evaluation and care are needed. Objective: To use quality improvement methods to determine if implementation of a standardized prenatal risk stratification system for fetal anomalies increases parent/infant bonding time while still allowing for safe postnatal surgical evaluation and management. OR use will also be evaluated. Design/Methods: An interdisciplinary group at the University of Michigan designed a tool to stratify delivery risk for fetuses with known fetal anomalies and possible need for surgical intervention termed “MINT” (Michigan Initial Neonatal Treatment). A driver diagram was created to identify processes affecting change. Baseline data were collected prior to implementation of the surgical MINT system in January 2023. Criteria for inclusion included a prenatal diagnosis of fetal anomaly anticipated to require surgical care in the neonatal period which would fall into an "Orange" category, for which delivery location would be determined by obstetric indications with an outcome measure of >90% receiving 60 minutes of bonding time. Exclusion criteria includes prematurity or other fetal/maternal factors necessitating OR delivery. Process measures include bonding time and use of OR for delivery. Balancing measures include adverse events during bonding time or need for escalation of support at delivery. Data will be collected over 1 year following implementation of the MINT system and PDSA cycles will be completed over the year.
