Reducing Term Admission from Respiratory Conditions by Decreasing Separation of Mother and Baby (Re-TARC). A quality improvement initiative at the Neonatal Unit, Univeristy Hospital Wishaw

Background: Unexpected term admission, a proxy indicator of harm occurring along the maternity-neonatal pathway form the largest proportion of admissions to neonatal units. On our unit, they account for just under 50% of admissions, leading indications being respiratory conditions and hypothermia. Skin to skin (STS) immediately after birth is known to enhance the natural bonding process and facilitate smooth postnatal adaptation. We describe our experience of reducing term admissions from respiratory condition (TARC) through implementation of in-theatre skin to skin (ITSTS) and NEWTT escalation pathway bundle.

Methods: Primary target was mothers presenting for elective Caesarean Sections (EL-CS) at term. Change process involved using Improvement methodology including process maps and cause and effect diagrams. Review of background term admission data (Badger-Net database) detailing leading admission indications, CS type, admission duration, type/length of respiratory support and whether ITSTS was offered and received was undertaken. Parental education on benefits of STS, staff training on providing ITSTS and offering ITSTS to mothers presenting for EL-CS. In theatre, monitoring leads were placed on mother’s back, blood pressure cuff on non-dominant arm and operating table placed at a slight head-up tilt to increase comfort. Once cord was cut, baby was dried, immediately placed in direct contact with mother’s chest and covered with pre-warmed blankets. STS continued for at least an hour. A NEWTT escalation pathway co-designed with staff was introduced to guide management of term babies with respiratory conditions following CS.

Results:

48% reduction in TARC following EL-CS

77% of babies who would otherwise have been separated remained with their mothers.

19% reduction in total term admission/1000 deliveries.

85% of EL-CS mums offered ITSTS and 85 % achieved it.

Conclusion: ITSTS and NEWTT escalation pathway has significantly decreased TARC, decreased separation of mothers and babies, increased parent satisfaction and fostered collaborative working. Requires ongoing QI work to sustain and spread.