An intervention to improve transitions from NICU to ambulatory care: quasi-experimental study

Moyer, Virginia A.; Papile, L.A.; Eichenwald, Eric; Giardino, Angelo P.; Khan, Myrna M.; Singh, Hardeep

doi:10.1136/bmjqs-2012-001726

Cited by 9 publications

(9 citation statements)

References 23 publications

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“…6 Another trial that randomly assigned families to discharge preparation with a health coach before discharge but did not provide postdischarge follow-up showed no difference in health care utilization at 1 month after discharge. 46 Combined with our data, these results suggest that home visiting may be an effective peridischarge intervention, but interventions may be needed both before and after NICU discharge.…”

Section: Homementioning

confidence: 53%

Perspectives of Low Socioeconomic Status Mothers of Premature Infants

et al. 2017

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BACKGROUND AND OBJECTIVES: Transitioning premature infants from the NICU to home is a highrisk period with potential for compromised care. Parental stress is high, and families of low socioeconomic status may face additional challenges. Home visiting programs have been used to help this transition, with mixed success. We sought to understand the experiences of at-risk families during this transition to inform interventions.

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Section: Homementioning

confidence: 53%

Perspectives of Low Socioeconomic Status Mothers of Premature Infants

et al. 2017

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“…** Both studies in which PCIs were evaluated (1 prepost study that was focused on children with multisystem complex illnesses and 1 prospective cohort study that was focused on the general population of children hospitalized) revealed an association with improved satisfaction. 43,86 CCIs were also associated with improved satisfaction across patient populations, including effective studies in children with chronic illnesses (n = 7), 43,44,48,49,52,53,64 patients in the NICU (n = 2), 78,80 and the general hospitalized population (n = 4). 86,87,89,94 CCIs that were associated with improved satisfaction included assistance with scheduling follow-up care, 43,53,89 in-home visits or follow-up telephone calls, 44,48,49,53,64,86,94 and intensive discharge planning.…”

Section: Results Of Individual Studies Regarding Patient And/or Caregmentioning

confidence: 99%

“…86,87,89,94 CCIs that were associated with improved satisfaction included assistance with scheduling follow-up care, 43,53,89 in-home visits or follow-up telephone calls, 44,48,49,53,64,86,94 and intensive discharge planning. 43,48,53,64,78,80,87,94 Similarly, FEIs were associated with improved satisfaction in children with chronic illnesses (n = 9), † † neonates (n = 3), 72,75,78 and general pediatric patients in the hospital (n = 4). 86,90,92,94 Effective FEIs included parental education (n = 13), ‡ ‡ written care plans for home (n = 1), 43 and cognitive behavioral therapy for parents (n = 1).…”

Section: Results Of Individual Studies Regarding Patient And/or Caregmentioning

confidence: 99%

Hospital-to-Home Interventions, Use, and Satisfaction: A Meta-analysis

Hamline

Speier

et al. 2018

Pediatrics

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Hospital-to-home transitions are critical opportunities to promote patient safety and high-quality care. However, such transitions are often fraught with difficulties associated with increased health care use and poor patient satisfaction. OBJECTIVE: In this review, we determine which pediatric hospital discharge interventions affect subsequent health care use or parental satisfaction compared with usual care. DATA SOURCES: We searched 7 bibliographic databases and 5 pediatric journals. STUDY SELECTION: Inclusion criteria were: (1) available in English, (2) focused on children <18 years of age, (3) pediatric data reported separately from adult data, (4) not focused on normal newborns or pregnancy, (5) discharge intervention implemented in the inpatient setting, and (6) outcomes of health care use or caregiver satisfaction. Reviews, case studies, and commentaries were excluded. DATA EXTRACTION: Two reviewers independently abstracted data using modified Cochrane data collection forms and assessed quality using modified Downs and Black checklists. RESULTS: Seventy one articles met inclusion criteria. Although most interventions improved satisfaction, interventions variably reduced use. Interventions focused on follow-up care, discharge planning, teach back-based parental education, and contingency planning were associated with reduced use across patient groups. Bundled care coordination and family engagement interventions were associated with lower use in patients with chronic illnesses and neonates. LIMITATIONS: Variability limited findings and reduced generalizability. CONCLUSIONS: In this review, we highlight the utility of a pediatric discharge bundle in reducing health care use. Coordinating follow-up, discharge planning, teach back-based parental education, and contingency planning are potential foci for future efforts to improve hospitalto-home transitions.

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“…2,3 Relatively little attention has been given to the impact and potential importance of this aspect of neonatal care, despite the huge volume of published literature on improving outcomes for preterm infants. 4 Improved education and information provided to families of preterm infants might improve the appropriate use of hospital and community health services after discharge, and reduce the numbers of babies readmitted to hospital, 5 although few studies have shown such a relationship.…”

Section: Chapter 2 Context and Backgroundmentioning

confidence: 99%

“…3 In the USA, the use of a health-coach programme to prepare families of infants with complex medical problems or born prematurely was explored. 5 The programme sought to help them to act as advocates for their infants. Families receiving health coaching were more likely to view the transition from hospital to home as positive within a few days of discharge, and to report confidence in knowing how to care for their baby.…”

Section: Mcgrathmentioning

confidence: 99%

Preparing for Home: a before-and-after study to investigate the effects of a neonatal discharge package aimed at increasing parental knowledge, understanding and confidence in caring for their preterm infant before and after discharge from hospital

Ingram

Blair

Powell

et al. 2016

Health Serv Deliv Res

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BackgroundImproved survival and shorter length of stay (LOS) for preterm infants, together with poorly organised discharge planning in some neonatal units, leaves many parents ill prepared to take their babies home, with increased use of out-of-hours services. Despite the importance accorded to family-orientated neonatal care by the Department of Health and the National Institute for Health and Care Excellence, few neonatal units offer structured, family-orientated discharge planning.ObjectivesTo implement a parent-orientated discharge planning approach (Train-to-Home package) for preterm infants and investigate the effects on parental self-efficacy scores, infants’ LOS and change in costs associated with use of health-care resources in the 8 weeks after discharge, before and after implementation.DesignA before-and-after study, investigating the effects of Train-to-Home package during two 11-month periods, immediately before and after its implementation.SettingFour local neonatal units in South West England.ParticipantsInfants without major anomalies, born at 27–33 weeks’ gestation, admitted to the participating units, and their parents.Train-to-Home interventionA parent-orientated package that incorporated approaches to improving parents’ involvement in, and understanding of, their baby’s needs. It comprised a train graphic and supporting care pathways to facilitate parents’ understanding of their baby’s progress through the neonatal unit, combined with improved estimation, soon after hospital admission, of the baby’s likely discharge date.Main outcome measuresPrimary – Perceived Maternal Parenting Self-Efficacy (PMPS-E) scores before and after implementing the Train-to-Home package; secondary – infant LOS and health-care utilisation after discharge.ResultsWe recruited 128 and 117 infants, respectively, in phase 1 (before implementation) and phase 2 (after implementation). In phase 2, parents reported improved understanding of babies’ progress, and preparedness for discharge, although PMPS-E scores did not change. The number of visits to emergency departments (EDs) fell from 31 in phase 1 to 20 in phase 2 (p < 0.05), with a significant reduction in associated health-care costs (from £3400 to £2200;p < 0.05) after hospital discharge. LOS did not change, but in both phases of the study > 50% of infants went home at > 3 weeks before their estimated date of delivery. Many nurses felt that the estimated discharge dates were over-optimistic, despite being based upon recent local data, and accurately predicting discharge dates for almost 75% of babies in the study.HarmsNo adverse consequences were identified.ConclusionsThe very early discharge of most babies made further shortening of LOS very difficult to achieve. Despite the lack of change of the parental self-efficacy scores, parents reported that their understanding and confidence in caring for their infants were improved by the Train-to-Home package, and the reduction in ED attendance and associated costs supports this assessment. The present study was limited by the tight time constraints for implementation, limited cascading of staff training and lack of staff confidence in the estimated dates of discharge.Future workProvision of the Train-to-Home package as a web-based system, allowing individual neonatal units and parents to access and use the materials, may allow more effective implementation in the future.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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An intervention to improve transitions from NICU to ambulatory care: quasi-experimental study

Abstract: NCT01088945.

Cited by 9 publications

References 23 publications

Perspectives of Low Socioeconomic Status Mothers of Premature Infants

Perspectives of Low Socioeconomic Status Mothers of Premature Infants

Hospital-to-Home Interventions, Use, and Satisfaction: A Meta-analysis

Preparing for Home: a before-and-after study to investigate the effects of a neonatal discharge package aimed at increasing parental knowledge, understanding and confidence in caring for their preterm infant before and after discharge from hospital

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