Improving care collaboration for NICU patients to decrease length of stay and readmission rate

Abstract

BackgroundMedically complex patients in neonatal intensive care units (NICUs) typically require long hospitalisations and care from multiple subspecialists. Scheduled multidisciplinary discussions could improve collaboration and continuity of care and thereby improve patient outcomes. The specific aims of the project were to decrease the average length of hospitalisation by at least 1 day and improve parent satisfaction ratings on a standard questionnaire by the end of our project’s first year, and to maintain a stable (or decreased) cause-related (30-day) readmission rate.MethodsWe designed a quality improvement project to enhance collaboration and continuity of care for medically complex infants cared for in the NICU of Brenner Children’s Hospital. Weekly multidisciplinary team meetings were held to discuss the long-term plan for patients who met specific criteria. Attendees included attending neonatologists, paediatric surgeons, a physical therapist, an occupational therapist, a speech therapist, a social worker, a nurse coordinator for palliative care, a family support coordinator, the NICU Nurse Manager, a hospital chaplain, mid-level providers, bedside nurses, a nurse quality improvement leader and the leaders and database manager for the quality improvement project. When needed for specific patients, a bioethicist was included.ResultsOne year after implementing the project, the average duration of hospitalisation had decreased by 6.5 days. Cause-related readmission rates decreased from 3.33% to 0.95%. Parent satisfaction scores did not change significantly.ConclusionsWeekly multidisciplinary meetings to coordinate and provide continuity of care for medically complex neonates in our NICU was associated with improved patient outcomes.

Smartphones and Text Messaging are Associated With Higher Parent Quality of Life Scores and Enrollment in Early Intervention After NICU Discharge

“…For example, previous studies have shown that readmission rates may be a function of the length of stay 38 and presence of a system in place to prepare parents with a solid foundation for discharge home. 39 It appears that access to communication technology may not be able to replace adequate preparation for discharge and the transition to home. In our study, email and smartphone use was associated with increased enrollment in community-based EI programs.…”

The Complexities Associated with Caring for Hospitalised Infants with Neonatal Abstinence Syndrome: The Perspectives of Nurses and Midwives

“…As a result, it was noted that infants with NAS would be allocated to agency staff resulting in a lack of continuity of care. This is of concern, as effective continuity of care has been known to decrease length of stay for infants in the NICU [ 23 , 24 ]. In addition to potentially increasing the length of stay for infants with NAS, lack of continuity of care, inadequate staffing levels and poor communication have been identified as causes of moral distress among nurses in the NICU setting [ 25 ].…”

Provider Networks in the Neonatal Intensive Care Unit Associate with Length of Stay

“…The rising complexity of EHR technology may better simulate direct collaboration between providers, but EHR data may fall short, and it is important to study intervention methods integrating asynchronous EHR communication and synchronous direct communication 35 . A study at the Brenner Children's Hospital implemented weekly meetings in the NICU involving all multidisciplinary providers to discuss long-term care plans for patients and successfully reduced LOS by 6.5 days one year into the study 36 . This could be a model for future intervention-based studies after accounting for supplemental network analyses.…”