The golden hour: A quality improvement project

G Suresh1, J Ince1, C Hirst1 E Barratt1, O Parker1, A Bean2

Background

• The ʻgolden hourʼ was adopted from adult trauma, specifically traumatic head injury, where prompt medical interventions were shown to reduce mortality1 .

• Reynolds et al. first implemented this concept in neonatal care in 20092 .

• Prompt management in the 1st hour improves both immediate and long term outcomes – intraventricular haemorrhage, hypothermia /glycaemia, bronchopulmonary dysplasia and retinopathy of prematurity1 .

Aims

LTHT definition of the ʻgolden hourʼ:

RESULTS 46 mins

There was a reduction in average times across all interventions, except PN. Surfactant, central line insertion and PN were achieved within the ʻgolden hourʼ. Surfactant is usually administered in delivery suite. There was a large delay in caffeine prescriptions for eligible babies. PN administration increased post intervention due to PN unavailabilities.

Within 1hr of admission for most interventions.

Within 6hrs of admission for central line insertion and parental nutrition (PN).

<34 weeks gestation

Methods

• Using electronic patient records, badgernet and K2, data was collected from Jan-Feb 2022 for all babies born at LTHT <34weeks.

• Departmental teaching, poster dissemination around the unit and social media posts about the golden hour, all delivered between MarchApril 2022.

• Re-audited babies born <34weeks at LTHT between May-July 2022.

Post intervention General improvements in achieving the golden hour after teaching and training, except for PN prescriptions.

Discussions

• With teaching and training, there was an improvement in compliance in most areas.

• Delays in registering a newborn onto the electronic system meant delays in prescription, thus education for midwifery team to aid faster registration of the baby on the electronic records.

• A longer time period of data collection with regular teaching and training, especially during doctors changeover time, to remind everyone of best practice.

• The aim is for this work in premature and low birthweight babies is to have a knock on effect on term babies.

REFERENCES

1Sharma, D., 2017. Golden hour of neonatal life: Need of the hour. Maternal health, neonatology and perinatology, 3(1), pp.1-21.