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Years Active: 2012-2015




The aim of this project is to improve outcomes of infants requiring resuscitation and stabilization by systematically implementing evidence based practices in the critical first hours of life.

As early outcome measures are difficult to obtain and controversial to interpret, we will focus on high reliability (>90%) implementation of specific practices focused on team communication, thermal regulation, surfactant administration, and oxygen dosing by pulse oximetry monitoring.

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.)

Monthly aggregate pre-resuscitation briefing completion percentage, preliminary provisional data in p-chart format subject to revision.
Monthly aggregate pre-resuscitation checklist completion percentage, preliminary provisional data in p-chart format subject to revision.
Monthly aggregate percentage of infants with FiO2 titrated into physiologic SaO2 range at 5 minutes of life, preliminary provisional data in p-chart format subject to revision.
Monthly aggregate elapsed time birth to initiation of antibiotic infusion, preliminary provisional data in Xm chart format subject to revision.

Active Participating

Hospital Teams

  • Children’s Hospital at Erlanger
  • Gateway Medical Center
  • Maury Regional Medical Center
  • Methodist LeBonheur Healthcare – Germantown
  • Methodist LeBonheur Healthcare – South Hospital
  • Monroe Carell Jr. Children’s Hospital at Vanderbilt
  • Regional One Health
  • Saint Thomas – Midtown Hospital
  • The University of Tennessee Medical Center

State Project Leaders

This project was led by a multidisciplinary team of neonatologists and nursing.  Ajay Talati, MD  and Kelly Smith, RN from Regional One Health, along with Dr. Bruce Jenkins, MD, MBA and Lynn Rosas, NNP from Methodist Lebonheur Germantown and Pediatrix, and Marta Papp, MD and Melanie Ford, RN from St. Thomas- Midtown led this project.



TIPQC is actively recruiting devoted health care professionals, community leaders and patient and family partners to further our mission of improving health outcomes for mothers and babies in Tennessee.