Article Text


1632 Quality Clinical Improvement: Prospective Test of Change
  1. AA Onibere1,
  2. J Ali2,
  3. J Egyepong3
  1. 1Luton & Dunstable University NHS Trust, Neonatal Unit, Luton
  2. 2Department of Paediatrics, Bedford General Hospital, Bedford
  3. 3Neonatal Intensive Care, Luton & Dunstable University Hospital, Luton, UK


Background Change is a fundamental component of continuous quality improvement. Surfactant clearly works better the earlier it is given in at risk babies. Previously, surfactant was given after transfer to the NICU due to concerns such as the grade of doctors who were present during these deliveries and endotracheal (ETT) position. With the introduction of resident consultants, the NICU service became a fully consultant-delivered care and therefore always present at the stabilisation of these infants.

Audit of Practice Showed Surfactant administration at mean of 39min (9 min outside our set protocol time), with wide variability.


  • Feasibility and safety issues of giving surfactant right after intubation on Delivery suite,

Mean time to surfactant administration and ETT position post-change.

Methods Time: 10/2010- 02/2011

  • Babies < 28wks and those at risk of RDS with ETT placement on DS in view of risk to RDS & for surfactant administration


  • Change of site of administration was easy

  • Shorter Mean time of administration from 39.1 to 12.8 min

  • Decrease in variability to time of administration (Standard Deviation decrease from 22.1 to 7.6 min (p<0.0001)

  • Identification of sub-optimal ETT position as a safety issue; introduction of evidence-base for ETT position, training, leading to significant improvement.

  • Use of evidence-based medicine, team training, audit cycle application to improve target outcomes and patient safety.


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