Objective <p>To decrease the time to achieve a reliable EKG signal in the delivery room from 102 s to 60 s.</p> Methods <p>Single center quality improvement (QI) initiative in a Fetal Care Center Special Delivery Unit (SDU) from May 2023 to March 2024. Key drivers were identified and PDSA cycles were performed; interventions included purchasing new leads, implementation of a new lead placement process, and institution of a Delivery Room Time Out. Time to reliable EKG signal and effective positive pressure ventilation (PPV) were monitored using run charts with data obtained from review of routine video recordings of resuscitation.</p> Results <p>Median time to EKG signal decreased from 102 to 58 s. Median time to effective PPV decreased from 92 to 44 s.</p> Conclusions <p>We successfully obtained EKG signals within 60 s in the delivery room; ongoing education was necessary to sustain this improvement.</p>