Variability in the systems of care supporting critical neonatal intensive care unit transitions

Heather C Kaplan; Erika M Edwards; Roger F Soll; Kate A Morrow; Jeffrey Meyers; Wendy Timpson; Howard Cohen; Marybeth Fry; Elizabeth Schierholz; Madge E Buus-Frank; Jeffrey D Horbar

doi:10.1038/s41372-020-0720-3

Variability in the systems of care supporting critical neonatal intensive care unit transitions

J Perinatol. 2020 Oct;40(10):1546-1553. doi: 10.1038/s41372-020-0720-3. Epub 2020 Jul 14.

Authors

Heather C Kaplan^{1

2}, Erika M Edwards^{3

4

5}, Roger F Soll^{3

5}, Kate A Morrow³, Jeffrey Meyers⁶, Wendy Timpson^{7

8}, Howard Cohen⁹, Marybeth Fry¹⁰, Elizabeth Schierholz^{11

12}, Madge E Buus-Frank^{13

14}, Jeffrey D Horbar^{3

5}

Affiliations

¹ Perinatal Institute, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. [email protected].
² Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA. [email protected].
³ Vermont Oxford Network, Burlington, VT, USA.
⁴ Department of Mathematics and Statistics, University of Vermont, Burlington, VT, USA.
⁵ Department of Pediatrics, The Robert Larner, M.D. College of Medicine, The University of Vermont, Burlington, VT, USA.
⁶ Division of Neonatology, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA.
⁷ Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
⁸ Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
⁹ Randall Children's Hospital, Portland, OR, USA.
¹⁰ Akron Children's Hospital, Akron, OH, USA.
¹¹ Children's Hospital of Colorado, Aurora, CO, USA.
¹² Data Science to Patient Value, University of Colorado, School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.
¹³ Division of Neonatology, The Children's Hospital, Lebanon, NH, USA.
¹⁴ The Dartmouth Institute for Health Policy and Clinical Practice at Geisel School of Medicine, Hanover, NH, USA.

Abstract

Objective: Assess practices supporting care transitions for infants and families in the neonatal intensive care unit (NICU) using a model of four key drivers: communication, teamwork, family integration, and standardization.

Study design: Single-day audit among NICUs in the Vermont Oxford Network Critical Transitions collaborative addressing policies and practices supporting the four key drivers during admission, discharge, shift-to-shift handoffs, within hospital transfers, and select changes in clinical status.

Results: Among 95 NICUs, the median hospital rate of audited policies in place addressing the four key drivers were 47% (inter-quartile range (IQR) 35-65%) for communication, 67% (IQR 33-83%) for teamwork, 50% (IQR 33-61%) for family integration, and 70% (IQR 56-85%) for standardization. Of the 2462 infants included, 1066 (43%) experienced ≥1 specified transition during the week prior to the audit.

Conclusions: We identified opportunities for improving NICU transitions in areas of communication, teamwork, family integration, and standardization.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Hospitals
Humans
Infant
Infant, Newborn
Intensive Care Units, Neonatal*
Patient Discharge*
Vermont