Improving Care for Infants With Neonatal Abstinence Syndrome: A Multicenter, Community Hospital–Based Study

Abstract

BACKGROUND: For infants with neonatal abstinence syndrome (NAS) in children's hospitals, treatment protocols emphasizing nonpharmacologic care have revealed improved hospital outcomes. We sought to improve NAS care within the community hospital setting through the implementation of an Eat, Sleep, Console (ESC) protocol. METHODS: Using a multidisciplinary quality improvement approach, we implemented an ESC protocol at 2 community hospitals. Primary outcomes were to decrease length of stay (LOS) by 20% and decrease scheduled morphine use to ,20%. Balancing measures included transfer to a higher level of care and unplanned 30-day readmissions. Data were extracted over 2 years, from 2017 through 2018. Interventions included an emphasis on nonpharmacologic care, the initiation of 1-time morphine dosing, flexible weaning schedules for infants on morphine, and the use of ESC scoring. Data were analyzed by using statistical process control. RESULTS: A total of 304 NAS patients were admitted from January 2017 to December 2018, with 155 during the postintervention period. After implementation, mean LOS decreased from 9.0 to 6.2 days, and morphine use decreased from 57% to 23%, both with special cause variation. There were 2 unplanned readmissions in the postintervention period compared with 1 preintervention and no transfers to higher level of care in either period. CONCLUSIONS: Implementation of a nonpharmacologic care protocol within 2 community hospitals led to significant and sustained improvement in LOS and morphine exposure without compromising safety. In this study, we illustrate that evidence-based practice can be successfully implemented and sustained within community hospitals treating infants with NAS.

Addressing drivers of healthcare utilization for neonatal opioid withdrawal syndrome

“…Our analysis corroborates the experience of other authors and institutions who have documented marked reduction in HU for infants at risk of NOWS by centering nonpharmacologic management and implementing ESC [ 10 , 12 – 19 , 23 , 31 – 35 ]. The need for pharmacologic management prolongs LOS [ 36 , 37 ], and LOS is often assumed to correlate with birth hospitalization cost for infants affected by NOWS.…”

“…The price of the hospital stay for a baby born with NOWS is over eight times that of an average newborn hospitalization [ 6 , 7 ], and the majority of these infants are covered by Medicaid [ 5 , 7 – 9 ]. Innovations to standardize and improve inpatient care of these infants, namely the introduction of the Eat, Sleep, and Console™ (ESC) bundle of care by Grossman et al in 2017, have demonstrated reduced HU in quality improvement (QI) analyses across a variety of institutional contexts [ 10 – 19 ].…”

Neonatal Opioid Withdrawal Syndrome (NOWS): A Transgenerational Echo of the Opioid Crisis

“…This approach was devised to reduce the amount of opioids required by infants for NOWS management and to shorten hospitalizations for NOWS infants. Studies have shown that the ESC approach is a promising intervention for the management of NOWS infants (Achilles and Castaneda-Lovato 2019;Blount et al 2019;Dodds et al 2019;Grisham et al 2019;Parlaman et al 2019). It is unclear whether there is sufficient evidence to recommend the ESC approach as part of standard-of-care.…”

Using the Eat Sleep Console Model to Promote Optimal Care and Outcomes for Infants With Neonatal Abstinence Syndrome

“…Our study expanded upon existing work with a focus on breastfeeding and weight loss, which have been minimally explored in the literature 10,14,20,21. Although the concept of utilizing rooming-in for infants with NAS has been discussed in prior ESC studies,10,12–15,18–20,22 this QI project expands on that work by reporting results on increased Pediatric Unit utilization, as a measure of rooming-in, and decreased NICU use.…”