Video laryngoscopy-assisted less-invasive surfactant administration quality improvement initiative

Abstract

ObjectiveTo describe the use of quality improvement methodology in transitioning from delivery of surfactant by INSURE (INtubation–SURfactant administration–Extubation) to video laryngoscope-assisted LISA (less-invasive surfactant administration) for infants with respiratory distress syndrome (RDS) receiving non-invasive ventilatory support.SettingTwo large neonatal intensive care units (NICUs) at Northwell Health (New Hyde Park, New York, USA).Study populationInfants with RDS receiving continuous positive airway pressure in the NICU and eligible for surfactant administration.ResultsLISA was initiated in our NICUs in January 2021, after extensive guideline development, education programmes, hands-on training and provider credentialing. Our Specific, Measurable, Achievable, Relevant and Timely aim was to deliver surfactant by LISA for 65% of total doses by 31 December 2021. This goal was achieved within 1 month of go-live. In total, 115 infants received at least one dose of surfactant during the year. Of those, 79 (69%) received it via LISA and 36 (31%) via INSURE. Two Plan–Do–Study–Act cycles contributed to improved adherence to guidelines on timely surfactant administration and both written and video documentation.ConclusionsSafe and effective introduction of LISA with the use of video laryngoscopy is achievable with careful planning, clear clinical guidelines, adequate hands-on training and comprehensive safety and quality control.