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Improving care collaboration for NICU patients to decrease length of stay and readmission rate

Abstract

Background Medically complex patients in neonatal intensive care units (NICUs) typically require long hospitalisations and care from multiple subspecialists. Scheduled multidisciplinary discussions could improve collaboration and continuity of care and thereby improve patient outcomes. The specific aims of the project were to decrease the average length of hospitalisation by at least 1 day and improve parent satisfaction ratings on a standard questionnaire by the end of our project’s first year, and to maintain a stable (or decreased) cause-related (30-day) readmission rate.

Methods We designed a quality improvement project to enhance collaboration and continuity of care for medically complex infants cared for in the NICU of Brenner Children’s Hospital. Weekly multidisciplinary team meetings were held to discuss the long-term plan for patients who met specific criteria. Attendees included attending neonatologists, paediatric surgeons, a physical therapist, an occupational therapist, a speech therapist, a social worker, a nurse coordinator for palliative care, a family support coordinator, the NICU Nurse Manager, a hospital chaplain, mid-level providers, bedside nurses, a nurse quality improvement leader and the leaders and database manager for the quality improvement project. When needed for specific patients, a bioethicist was included.

Results One year after implementing the project, the average duration of hospitalisation had decreased by 6.5 days. Cause-related readmission rates decreased from 3.33% to 0.95%. Parent satisfaction scores did not change significantly.

Conclusions Weekly multidisciplinary meetings to coordinate and provide continuity of care for medically complex neonates in our NICU was associated with improved patient outcomes.

  • healthcare quality improvement
  • patient-centred care
  • patient satisfaction
  • collaborative
  • breakthrough groups

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors CDW conceptualised and designed this quality improvement study, collected the data, analysed and interpreted the data, drafted the initial manuscript and approved the final manuscript as submitted. JC helped collect the data, assisted in analysis of the data, helped draft and revise the manuscript and approved the final manuscript as submitted. TMOS helped conceptualise the study, assisted in analysis of the data, helped draft and revise the manuscript and approved the final manuscript as submitted.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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