738 - Decreasing NICU Transfers for Infants Born Late Preterm via Optimization of Thermoregulation and Glucose Management
Sunday, April 30, 2023
3:30 PM – 6:00 PM ET
Poster Number: 738 Publication Number: 738.343
Michelle Gontasz, Johns Hopkins University School of Medicine, Cockeysville, MD, United States; Margaret Sarezky, Johns Hopkins University School of Medicine, Fulton, MD, United States; Giancola Katharine, Johns Hopkins Bayview Medical Center, Baltimore, MD, United States; Kristina Migaleddi, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Kate Hackett, Johns Hopkins University School of Medicine, Belcamp, MD, United States
Clinical Associate/Instructor Johns Hopkins University School of Medicine Cockeysville, Maryland, United States
Background: Late preterm infants are often well enough to not require initial admission to the Neonatal Intensive Care Unit (NICU)but are at risk for complications of prematurity. This population is also underrepresented in research and quality improvement (QI). At this hospital, infants with gestational age (GA) ≤ 34 0/7 weeksand birth weight ≥ 1800 gramsin room airareadmitted to the Mother Baby Unit (MBU). However,many require subsequent transfer to this level III NICU, leading to greater separation from family and utilization of higher level of care. Objective: This QI project aimed to decrease the percentage of34-35 6/7 weeksGAinfants with birth weight ≥1800 grams requiring transfer from the MBU to the NICU from 39% to ≤20% by March 2022. Design/Methods: This QI project utilized the Plan-Do-Study-Act (PDSA) model. A group of medical and nursing leaders from labor and delivery, NICU, andnurserycollaborated to performretrospective chart review to identify reasons for patient transfer and identify key drivers (Figure 1). Because the most common reasons for transfer included hypothermia and hypoglycemia, the interventions focused on updating MBU policies to standardizevital sign surveillance, routine use of isolettes for infants with GA <36 weeks or birth weight <2200 grams, and blood glucose management, including glucose gel. The group emphasized staff education, simulation, and inter-team communication. A Statistical Process Control (SPC) P-chart trackedthe percentage of newborns 34-35 6/7 weeks and ≥1800 gramstransferred from the MBU to the NICU each month. Months witha denominator of zero were hidden from control limit calculations. The process measure was the rate of routine isolette care utilization. The balancing measure was readmissions to the birth hospital. Results: From January 2021 to September 2022, there were 41newbornswho met inclusion criteria. The P-chart for the percentage of infants requiring transfer (Figure2)showed a downward center line shift from 39% to 12.5% and maintained. 81% of eligible patients received routine isolette care in the post-implementation period. Of those who did not, all were larger than 2200 gramsandGAwas estimated due to late or no prenatal care. There were no readmissions to the birth hospital.
Conclusion(s): This QI project successfully decreased the percentage of late preterm infants transferred from the MBU to NICU by implementing practice changes targeting thermoregulation and hypoglycemia management. The team continues to follow for sustained improvement.
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