In 2011, the TIPQC membership voted to develop and pilot test an improvement project to facilitate implementation of Neonatal Resuscitation Program guidelines as part of a larger effort to systematically review and refine policies and practice in the first hours of life for critically ill infants.

Teams successfully implemented and achieved high-reliablity performance for pre-resusciation briefings and checklist use (Preliminary provision QI data at right). Successful titration of supplemental O2 into target SaO2 ranges at 5 minutes of life proved challenging, though modest system improvement was apparent in the aggregate data (Preliminary provision QI data at right). Surfactant utilization strategies changed markedly over the course of the project. This measure achieved high-reliability early in the project, however the measure was subsequently abandoned as consensus on early surfactant use in targeted populations shifted to favor an initial trials of CPAP prior to intubation and later initial surfactant administration.

In addition to the initially selected measures, pilot centers recognized an improvement opportunity in the processes and systems required for initial administration of intravenous fluids and antibiotics in the NICU. Process measures for time to administration were added for the statewide kickoff, and substantial progress was made in improving the time to administration of the initial antibiotic dose. (Preliminary provisional QI data at right.)