Reducing Newborn Screening Transit Time: A Residency-Wide Quality Improvement Initiative

Objectives: The California Newborn Screening Program (NBSP) diagnoses diseases for actionable treatment (1).The California Department of Health (DPH) recommends at least 85% of all NBSP specimens have a transit time of 2.00 days for patient safety.At project initiation, only 66% of NBSP specimens from the UCSF well-baby nursery met this standard.Residents identified this deficiency as an opportunity to lead a quality improvement (QI) project.Program leadership supported this endeavor for residents to gain hands-on training in QI strategies, an area identified in the literature as lacking in pathology training (2-4).Methods: The pathology residents initiated this QI project by conducting a failure modes and effects root cause analysis (RCA) to map out specimen transit workflow.A retrospective review of cases with transit times >2 days was performed to identify sources of delay.Based on this analysis, the group chose to close the drying rack in the newborn nursery and shift drying responsibilities to the laboratory.Education and coordination were performed with both nursing and laboratory staff around this workflow change.Data was subsequently tracked to monitor intervention efficacy.To ensure clear communication and continuity, the resident rotating on the pediatric hematology service was designated the monthly project leader with responsibilities including providing updates at a monthly all-resident virtual conference.Results: The RCA and retrospective review identified three primary sources of delay: excess drying time, accession protocol at the NBSP lab, and lack of daily courier services.The source of delay actionable by the trainees was the excess drying time in the nursery, causing 57% of sample delays.After discussions and education with nursing and lab staff, the drying rack was closed, and drying responsibilities shifted to lab staff.As a result, 92% of NBSP samples achieved a transit time of 2.00 days.The success in the well-baby nursery motivated the NICU nursery to adopt a similar workflow change, achieving a similar improvement in sample transit times.Notably, eight residents co-led this project, gaining hands-on experience in implementing QI strategies.Conclusions: This project demonstrates an effective solution to improve transit times for NBSP samples.Importantly, as the need for greater QI education in training is recognized in the literature (2-4), this study highlights a mechanism to leverage a straightforward solution to improve patient safety in a practical and resident-led project.Trainees learned how to perform RCA, interdepartmental communication, retrospective data evaluation, and strategies to communicate successes in QI.