Redesigning care to support earlier discharge from a neonatal intensive care unit: a design thinking informed pilot

Abstract

BackgroundPreterm infants may remain in neonatal intensive care units (NICUs) to receive proper nutrition via nasogastric tube feedings. However, prolonged NICU stays can have negative effects for the patient, the family and the health system.AimTo demonstrate how a patient-centred, design thinking informed approach supported the development of a pilot programme to enable earlier discharge of preterm babies.MethodWe report on our design thinking-empathy building approach to programme design, initial outcomes and considerations for ongoing study.ResultsThrough the use of design thinking methods, we identified unique needs, preferences and concerns that guided the development of our novel early discharge programme. We found that stable, preterm infants unable to feed by mouth and requiring nasogastric tubes can be cared for at home with remote patient monitoring and telehealth support. In addition, novel feeding strategies can help address parental preferences without compromising infant growth.ConclusionA patient-centred, design thinking informed approach supported the development of a pilot programme to enable earlier discharge of preterm babies. The programme resulted in a reduced length of stay, thereby increasing NICU bed capacity and limiting hospital turn-aways.

Hurdles of innovation—insights from a new healthcare delivery innovation program

“… 37 , 38 , 39 We recognize that innovation requires an understanding and responsiveness to local context and resource limitations—and that iteration in response to challenges is to be expected. 13 Although the Incubator is still relatively new, teams are beginning publish on their experience—highlighting the iterative nature of their work to achieve tangible benefit 40 , 41 Initial debriefings with these teams highlight that the structures and supports provided by the Incubator, especially the dedicated time to focus on innovation, were key to their successes.…”

Influences of a Remote Monitoring Program of Home Nasogastric Tube Feeds on Transition from NICU to Home

“…Programs in the United States more typically utilize follow-up in ambulatory settings [10][11][12][13][14][15] . More recently, remote patient monitoring (RPM) has been described as a facilitator of discharge to home with NGT feeds [16][17][18][19][20][21][22][23] . RPM is a form of telemedicine that uses digital health technologies in the home to allow patients to collect and transmit data to their health care team, typically supplemented with phone or video communication 24 .…”

“…[10][11][12][13][14][15] More recently, remote patient monitoring (RPM) has been described as a facilitator of discharge to homes with NGT feeds. [16][17][18][19][20][21][22][23] RPM is a form of telemedicine that uses digital health technologies in the home to allow patients to collect and transmit data to their health care team, typically supplemented with phone or video communication. 24 In May 2019, the Oregon Health & Science University Doernbecher Children's Hospital NICU started an RPM program called Growing @ Home (G@H) for infants who remained admitted to the NICU with inadequate oral feeding alone.…”

Remote monitoring for neonates requiring continued nasogastric tube feeding: implementation, patient characteristics, and early outcomes

“…More recently, two separate NICU RPM programs have been described in the United States that facilitate early discharge with NGT feeding for babies with IOF. (22,23) In May 2019, the Oregon Health & Science University Doernbecher Children's Hospital (DCH) NICU started an RPM program called Growing @ Home (G@H) for babies who remained admitted to the NICU with IOF alone. Here we describe the implementation of G@H, including program work ows and feasibility, and evaluate characteristics and outcomes of the initial 109 babies discharged on the program.…”