Improving Skin-to-Skin Contact During the Golden Hour for Neonates ≥34 Weeks: Single-Site Quality-Improvement Initiative Study.

Introduction: Early skin-to-skin contact (SSC) during the golden hour after birth offers multiple benefits for newborns and mothers. Despite World Health Organization and United Nations Children's Fund recommendations, baseline SSC rates in our unit were only 7% for vaginal deliveries and 10% for cesarean deliveries. We therefore aimed to increase the early SSC rate to more than 80% from baseline within 10 weeks. Methods: A multidisciplinary team of doctors and nurses conducted this quality improvement initiative in Southern India over 10 months (September 2023-June 2024) using the point-of-care quality improvement model (POCQI_learner_manual_ver 03_2020.pdf). Stable neonates of 34weeks or older included, measured baseline rates during 4 weeks, and tested 4 change ideas during the next 10 weeks. We assessed sustainability for 6 months after the intervention. Results: Out 1312 neonates of gestation age 34 weeks or older, 854 were eligible (513 vaginal deliveries and 341 cesarean deliveries). The mean gestational age was 37 ± 1 weeks (mean ± SD), and the mean birth weight was 2,929 ± 445 g (mean ± SD). Implementation of change ideas-including standardized documentation, simulation-based training, and task-sharing with nursing students and aides-improved SSC rates to 85% for vaginal deliveries and 91% for cesarean deliveries. We sustained these gains, with rates consistently remaining more than 85% during the sustainability period. Conclusions: This quality improvement initiative enhanced healthcare providers' knowledge, competence, and confidence in facilitating SSC, resulting in a marked and sustained change in practice. Future studies should explore scalability across diverse healthcare settings.