Process Improvement for Family-Centered Congenital Heart Disease Deliveries

BACKGROUND: Perinatal care coordination for the birth of infants with prenatally detected ductal-dependent congenital heart disease (DDCHD) has historically been limited by the siloing of cardiologists and neonatologists and by singular focus on risk reduction. The aim of this study was to increase time for parent-infant bonding and decrease overutilization of medical resources by developing and implementing a standardized delivery stratification system for infants with CHD. METHODS/INTERVENTIONS: Over the course of multiple Plan-Do-Study-Act cycles from 2015 to 2023, we identified risk factors for respiratory intervention immediately after birth among infants with DDCHD, drivers of unnecessary intervention and resource utilization, and barriers to allowing time for parent-infant bonding. This led to development of standardized documentation and communication and a color-coded risk-stratification system that allowed for the identification of a low-risk cohort of infants eligible for demedicalized, immediate postnatal care despite the presence of critical CHD. RESULTS: Through a series of process improvements and implementation of a delivery risk-stratification system, we were able to maintain neonatal safety while decreasing use of the operating room for vaginal deliveries from 100% to 10% and increasing the rate of time for parent-infant bonding in the first hours of life from 62% to 91%. CONCLUSION: Multidisciplinary collaboration and iterative quality improvement work supported the safe improvement in allowing parent-infant bonding after birth for infants with critical CHD with a decrease in unnecessary respiratory intervention and obstetric resource utilization. Our findings support adoption of a collaborative risk-stratification approach for other congenital anomaly cohorts.