Fellow John R. Oishei Children's Hospital Buffalo, New York, United States
Background: “Golden Hour” refers to the sixty minutes following birth in which medical care to prevent permanent damage to an infant is most effective. Prompt care within that first hour has been shown to reduce morbidity and mortality in premature infants. These neonates require numerous interventions including maintaining thermoregulation, respiratory management, gaining intravascular access, administering intravenous fluids, and initiating antibiotics when indicated. The sooner these components are completed, the better the long-term outcomes are. The Golden Hour initiative is composed of standardized evidence-based practices to achieve these goals in order to optimize short-term and long-term outcomes in this vulnerable population. Preliminary data from January 2022 to August 2022 for our NICU reflected a lack of standardization in the initial stabilization of infants < 30 weeks GA, leading to a delay in achieving Golden Hour. Objective: To improve completion of the Golden Hour initiative in all inborn babies < 30 weeks GA within 60 minutes post birth to 40% by January 2024. Design/Methods: A multidisciplinary team (i.e.; NICU Medical Director, Neonatology fellow, Nurse educators, Managers, Nurses, Advance 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. Baseline data highlighted significant delays in completing components of Golden Hour, which led to 20% achievement in this patient population. Our outcome measures include increasing adherence to the Golden Hour protocol by implementing process measures such as the creation of the multidisciplinary Golden Hour team, predelivery team preparation, implementing infographics, and providing extensive education to standardize workflow. Data is being reviewed every two weeks and multiple PDSA cycles are ongoing. We hope to target areas needing improvement and achieve our desired metrics by March 2024.
