Quality Strategies Initiative for the Improvement of Delayed Cord Clamping Among Preterm Neonates: A Quality Improvement Study in Saudi Arabia

Abstract

Background: Delayed cord clamping (DCC) has significant impact on health and well-being of preterm and term infants locally and worldwide. Effect of autotransfusion from delayed cord clamping has demonstrated significant beneficial effects in decreasing neonatal morbidity and mortality. However, this implementation has not been routinely established in clinical practice. Aim: To improve the percentage of eligible infants who receive DCC among preterm newborns at tertiary hospital in Riyadh, Saudi Arabia. Methods: The study was conducted between June 2023 and June 2024 at tertiary hospital, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia. We applied Plan-Do-Study-Act (PDSA) as a structured approach. The study population was defined as preterm infants aged <35 weeks. Interventions that were used included: workforce education, improving standardized procedures, monitoring and evaluation, and resources management. The DCC compliance rate was measured, in addition to employee training attendance and documentation methods. Results: At the beginning of this study, the rate of DCC procedure was very low, and accounted only for 0% to 3%. After the interventions (Education and training, policy development, process monitoring and audits, and resource allocation) were applied, the rate of DCC increased to 92%, and this prevalence remained above the benchmark (60%), plateauing at above 90%. There were no reported maternal or neonatal adverse events. Conclusion: This study confirmed that the rate of DCC increased after using the appropriate organized interventions. Applying the same or similar approach in other medical settings may be a valuable contributor in improving neonatal outcomes in addition to improve the standards related to DCC practices.