P0147 - Reducing Turnaround Times (TAT) of Newborn Screens (NBS) in a level IV NICU: A Quality Improvement Initiative

Background: Newborn screening is an effective tool for early recognition and treatment of genetic and metabolic disorders. Despite its known utility, achieving less than 48 hour goal TAT remains a challenge for referral NICUs.
SMART aim: To reduce the average monthly NBS TAT by 20% over 12 months in our level IV NICU. Balancing measures: unacceptable samples and missing information.

Methods: Observational time series since May 2019 using Plan-Do-Study-Act (PDSA) model for improvement. Process mapping and baseline data analysis were done to identify TAT delays. Figure1 highlights aims, key drivers and interventions. Statistical process control charts were used to display average monthly TAT, unacceptable samples, missing information and percentage of samples with TAT less than 48hours.

Results: 133 NBS have been sent since May 2019. A 45% reduction in average TAT from 71.8 to 39.7hours was achieved with 8 consecutive points falling below the mean since interventions indicating special cause improvement with minimal variability(Figure2). These interventions have not led to an increase in unacceptable samples or missing information(Figure3). A consistent increase in the percentage of samples with TAT less than 48hrs was attained with 5 consecutive data points falling above the mean of 69.4% (Figure4).

Conclusions: Implementation of process changes in NBS sample collection windows and streamlining of specimen processing and shipping can result in a steady reduction in TAT without increasing the number of unacceptable samples or missing information. Continued surveillance and buy-in from stakeholders is vital to ensuring change and sustainability.