NHS Hospital Quality Improvement project reduces term NICU admissions after elective caesarean section

Ashford & St Peters NHS Hospital recently reported (EAPS, Vienna, 2024) on a quality improvement project that was established to reduce term admissions to their neonatal unit after elective caesarean sections. The project found that prioritising skin to skin led to an overall reduction of term admissions, reduced mother-infant separation, reduced the length of hospital stay, increased parental satisfaction and demonstrated an overall cost reduction.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 1: WARMS project initiatives at Ashford & St Peters NHS Hospital

Methods

The team first conducted retrospective data analysis for term infants born via ELCS between March and August 2022, observing a rise in term neonatal admissions, peaking at 45% of term ELCS births in August. To counter this trend, they launched the WARMS project in September 2022, monitoring prospective data up to May 2023.

The key interventions included:

  • Early uninterrupted skin to skin experience
  • Minimizing medical interventions that could separate mother and baby
  • Feedback loops to gauge staff and parental engagement and ensure the implementation of the protocol

Results

The WARMS project demonstrated significant success. Post-implementation NICU admissions following Cat 4 ELCS reduced significantly by at least 40% from baseline. Staff showed strong engagement with the new protocol, and feedback from parents indicated high satisfaction.

Conclusions

The implementation of the WARMS project led to a meaningful reduction in NICU admissions for term infants delivered by elective Caesarean section. Small achievable changes, minimising interventions and facilitating skin to skin care helped achieve normothermia and reduce respiratory symptoms which led to an overall reduction of term admissions, reduced separation, reduced hospital stays, increased parental satisfaction and cost reductions.

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References

Sturt V., Jennis L., & Woolger K.,( 2024). ‘WARMS’ a quality improvement project to reduce term admissions to a neonatal unit from elective caesarean sections (ELCS). European Academy of Paediatric Societies poster. October 2024.

Bonner O, Beardsall K, Crilly N, Lasenby J. ‘(2017) There were more wires than him’: the potential for wireless patient monitoring in neonatal intensive care. BMJ innovations. 2017 Feb 1;3(1).