Increasing Timely Family Meetings in Neonatal Intensive Care: A Quality Improvement Project

Abstract

OBJECTIVES: Timely multidisciplinary family meetings (TMFMs) promote shared decision-making. Despite guidelines that recommend meetings for all patients with serious illness, our NICU TMFM rate was 10%. In this study, we aimed to document a meeting within 5 days of hospitalization for 50% of all new NICU patients hospitalized for ≥5 days within 1 year of introducing interventions. METHODS: A multidisciplinary improvement team used the Model for Improvement to achieve the study aim by targeting key drivers of change. To make meetings easier, we introduced scheduling and documentation tools. To make meetings more customary, we provided education and reminders to professionals. We defined a TMFM as a documented discussion between a parent, a neonatologist, and a nonphysician professional, such as a nurse, within 5 days of hospitalization. We used statistical process control charts to assess the monthly proportion of new patients with a TMFM. In surveys and feedback sessions, family and clinician satisfaction with communication was assessed. RESULTS: TMFM documentation tripled during the intervention year when compared with the previous year (28 of 267 [10.5%] vs 70 of 224 [31.3%]; P < .001), revealing evidence of special cause variation on the statistical process control chart. Clinicians predominantly used ad hoc documentation instead of our scheduling and documentation tools. Parental satisfaction with care and communication did not vary significantly after interventions. Most physicians reported satisfaction with meetings. Nurses reported feeling empowered to request meetings. CONCLUSIONS: An academic, quaternary-care NICU tripled TMFM documentation after introducing a multifaceted intervention. This improvement may represent changes in professionals’ attitudes about providing and documenting family meetings.

Strategies to improve interpersonal communication along the continuum of maternal and newborn care: A scoping review and narrative synthesis

“…Sixty-seven studies (n = 67/128) used tools to improve interpersonal communication between health workers and women and partners: decision aids, visual aids, prompts and scripts, and guidelines based on specific theory-based approaches to communication [ 25 , 26 , 31 – 33 , 35 – 37 , 43 – 45 , 48 , 50 – 52 , 54 , 57 , 60 , 62 , 64 , 65 , 67 , 69 – 71 , 75 , 78 – 80 , 82 , 83 , 85 , 87 – 89 , 92 , 93 , 95 – 100 , 102 – 104 , 108 , 109 , 116 , 117 , 123 – 126 , 128 – 132 , 134 – 136 , 144 , 154 , 160 , 164 , 166 – 168 , 172 , 174 ].…”

“…An example of a culturally sensitive visual aid was a cloth embroidery depicting safe maternal practices in pregnancy [ 62 ]. Prompts (n = 11/67) were also regularly used [ 26 , 31 , 54 , 67 , 85 , 87 , 88 , 92 , 123 , 129 , 175 ]. In these studies, health workers (or women [ 88 ]) received a (computer-assisted) cue or prompt to deliver or ask for counselling.…”

“…In these studies, health workers (or women [ 88 ]) received a (computer-assisted) cue or prompt to deliver or ask for counselling. A fourth type of tool used in studies was a script, or guideline regarding a specific approach to interpersonal communication often based on underlying communication theory (n = 30/67) [ 25 , 26 , 31 , 54 , 57 , 67 , 78 , 79 , 82 , 85 , 89 , 92 , 98 – 100 , 102 – 104 , 109 , 116 , 125 , 129 – 132 , 144 , 154 , 160 , 164 , 166 ]. This was primarily developed for the health worker, for example a small card with sample questions [ 166 ], a more extended script package [ 102 ], a checklist [ 85 ], or the use of Gamble’s approach to guide counselling [ 82 ].…”

“…Peremans et al 2010 [ 64 ] aimed to improve the quality of communication for contraceptive counselling by general practitioners (GPs), who used a decision aid during contraceptive counselling or were confronted with a ‘standardized patient’ who was empowered to ask a few additional questions regarding their contraceptive options. Three of the seven studies used a multidisciplinary approach to improve interpersonal communication, with joint consultations involving various medical specialists, psychologists and/or nurses [ 27 , 67 , 107 ].…”

“…Other strategies to improve interpersonal communication. Seven studies used other strategies to facilitate interpersonal communication, including facilitation, women and partner or family empowerment, and multidisciplinary consultations [27,34,57,64,67,107,150]. The strategy of La Rosa et al [150] consisted of health workers wearing a white coat to increase patients' confidence or to act as a non-verbal communication facilitator.…”