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

Journal of Perinatology volume 40, pages 1546–1553 (2020)Cite this article

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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.

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Fig. 1: Key driver diagram.
Fig. 2: Hospital variation in percent of policies, guidelines and procedures supporting communication, teamwork, standardization, and family integration.

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Funding

RFS, JDH, and KAM are employees of the Vermont Oxford Network (VON). MEB-F was employed by VON during the conduct of this work. EME is funded by a grant from VON to the University of Vermont. HCK, JM, WT, HC, and MF have served as faculty for VON.

Author information

Authors and Affiliations

  1. Perinatal Institute, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Heather C. Kaplan

  2. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Heather C. Kaplan

  3. Vermont Oxford Network, Burlington, VT, USA

    Erika M. Edwards, Roger F. Soll, Kate A. Morrow & Jeffrey D. Horbar

  4. Department of Mathematics and Statistics, University of Vermont, Burlington, VT, USA

    Erika M. Edwards

  5. Department of Pediatrics, The Robert Larner, M.D. College of Medicine, The University of Vermont, Burlington, VT, USA

    Erika M. Edwards, Roger F. Soll & Jeffrey D. Horbar

  6. Division of Neonatology, Golisano Children’s Hospital, University of Rochester Medical Center, Rochester, NY, USA

    Jeffrey Meyers

  7. Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Wendy Timpson

  8. Department of Pediatrics, Harvard Medical School, Boston, MA, USA

    Wendy Timpson

  9. Randall Children’s Hospital, Portland, OR, USA

    Howard Cohen

  10. Akron Children’s Hospital, Akron, OH, USA

    Marybeth Fry

  11. Children’s Hospital of Colorado, Aurora, CO, USA

    Elizabeth Schierholz

  12. Data Science to Patient Value, University of Colorado, School of Medicine, Anschutz Medical Campus, Aurora, CO, USA

    Elizabeth Schierholz

  13. Division of Neonatology, The Children’s Hospital, Lebanon, NH, USA

    Madge E. Buus-Frank

  14. The Dartmouth Institute for Health Policy and Clinical Practice at Geisel School of Medicine, Hanover, NH, USA

    Madge E. Buus-Frank

Authors
  1. Heather C. Kaplan
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  2. Erika M. Edwards
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  3. Roger F. Soll
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  4. Kate A. Morrow
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  6. Wendy Timpson
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  7. Howard Cohen
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  8. Marybeth Fry
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  9. Elizabeth Schierholz
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  10. Madge E. Buus-Frank
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  11. Jeffrey D. Horbar
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Contributions

HCK substantially contributed to the conception and design of the work, analyzed and interpreted the data, drafted the initial manuscript, created the tables and figures, and critically revised the manuscript for important intellectual content. EME and KAM substantially contributed to the analysis and interpretation of the data, assisted in creation of tables and figures, and critically revised the manuscript for important intellectual content. JM, WT, HC, ES, RFS, MEB-F, JDH, and MF substantially contributed to the conception and design of the work and critically revised the manuscript for important intellectual content.

Corresponding author

Correspondence to Heather C. Kaplan.

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The authors declare that they have no conflict of interest.

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Kaplan, H.C., Edwards, E.M., Soll, R.F. et al. Variability in the systems of care supporting critical neonatal intensive care unit transitions. J Perinatol 40, 1546–1553 (2020). https://doi.org/10.1038/s41372-020-0720-3

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