Improving care collaboration for NICU patients to decrease length of stay and readmission rate
Cherrie D Welch, Jennifer Check, T Michael O’Shea; BMJ Open Quality 2017, Volume 6, Issue 2
BAPM NSQI 2 – Team Communication
BAPM NSQI 5- Collaborative multidisciplinary care for babies with complex conditions
In this fascinating paper the authors describe how a multidisciplinary quality improvement project reduced length of stay and readmission rate for medically complex neonatal patients in a level 4 NICU in USA. The aim of the project was to increase continuity and collaboration of care for infants who were expected to have prolonged hospitalisations. The intervention consisted of weekly 1hour multidisciplinary meeting of health professionals with the purpose of (1) identifying and removing barriers to progression of care and discharge and (2) arranging for a smooth transition to home and post-hospital care. The meeting attendees included neonatologists, paediatric surgeons, physical therapist, occupational therapist, speech therapist, social worker, nurse coordinator for palliative care, family support coordinator, NICU Nurse Manager, hospital chaplain, mid-level providers, bedside nurses, nurse quality improvement leader and database manager for the quality improvement project. One year after implementing the project, the average duration of hospitalisation had decreased by 6.5 days and cause-related readmission rates decreased from 3.33% to 0.95%.
This quality improvement endeavour is replicable in UK too where care of a newborn with complex medical or surgical problem is provided across many services across the neonatal network, specialist services and the community services.
Reviewed by Ambalika Das on behalf of the Publications Team
Utilizing Quality Improvement Science to Improve Resident Neonatal Resuscitation Skills in the
Bertoni C, et al., Pediatrics May 2018; 142 (1)
BAPM NSQI 1: Generating and developing guidelines,
BAPM NSQI 2: Supporting team communication
The team from Nationwide Children’s Hospital (Columbus, OH) present a well circumscribed piece of work aiming to increase the skills and confidence of residents (ST1-5 equivalents) in neonatal resuscitation. Drivers for their project were very relatable, for example, the pressures of hours restrictions (arguably even greater in the UK/EU) as a significant challenge for effective and comprehensive training in resuscitation. Desirable and appropriate levels of skill and practice are difficult to achieve. The unit housed 5000 deliveries/year and a 49-cot NICU, larger than many but comparable to some in the UK. They clearly delineate SMART objectives and use great supporting visuals to convey their improvement process. IHI methodology, well established worldwide, was implemented throughout this project supporting its generalisability. PDSA cycles encompassed a number of straightforward interventions such as a radiant warmer checklist, “real time” feedback after live resuscitations and simulation based senior reviews of skills acquisition; time consuming, but not costly. Though skills advanced, for example effective communication of heart rate increasing from 60% to 93%, and were sustained in the short term, residents’ reported comfort levels did not see similar increases. The team rightly point out that the increased insight to knowledge gaps and areas for development may contribute significantly to this.
The project setting is relevant to workload, context and skill mixes in the UK. The presence of additional team members experienced in some elements of resuscitation in the (Respiratory Therapists) draws in additional pressures on time and training over and above those we face in the UK; the project is generalizable to our needs. Overall the methodology and interventions are well explained, straightforward to follow and well presented in this piece of work. It’s a nice example of what a team can achieve with clear objectives, plenty of effort and regular review.
Reviewed by Chantelle Tomlinson on behalf of the Publication Team
Previous Publication Reviews
QI publications group: Ambalika Das (Lead), Chantelle Tomlinson, Sarah Bates, Lisa Barker.