Improving neonatal resuscitation in Tennessee: a large-scale, quality improvement project

We report a statewide collaborative quality initiative to improve resuscitation and stabilization practices following introduction of the 6th edition of the Neonatal Resuscitation Program. Participants drafted a consensus toolkit of interventions and corresponding measures. Hospital teams collected baseline data, and implemented changes using PDSA-cycles and statistical process control charts. Nine Tennessee NICUs submitted data on 3771 resuscitations. “Special cause” improvements were achieved and sustained for pre-resuscitation checklists (77–90%) and team briefings (80–92%). Time to intravenous access (50–42 min), glucose infusion initiation (73–60 min), and antibiotic dosing (113–98 min) were also significantly reduced. Teams were unable to meet new NRP oxygen saturation targets. Improvements in post-resuscitation debriefing were not sustained, while communication with parents declined significantly (68–60%). Large-scale collaboration facilitated statewide implementation of new guidelines, while highlighting under-appreciated systems challenges among competing resource demands.