705 - Improving Discharge & Transition to Outpatient Care for Preterm Infants with Bronchopulmonary Dysplasia

Poster Number: 705
Publication Number: 705.153

Nicole Stephenson, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; William Stoudemire, University of North Carolina, Chapel Hill, NC, United States; Susan Lynch, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States

Background: Despite advances in neonatal care, bronchopulmonary dysplasia (BPD) remains the most common morbidity of prematurity. Complex BPD patients are managed by neonatologists during the hospitalization, then care shifts to outpatient specialists, including pediatric pulmonologists, following discharge. During this transition, variations in care among the medical team and poor communication with families can lead to inconsistent care and adverse outcomes. Our project introduced a comprehensive approach to discharge planning in order to standardize care and improve transition to outpatient care.

Objective: We aim to increase SAFER discharges from 6% to 95% by January 2023, for infants with BPD who are discharged from the UNC NICU with respiratory support.

Design/Methods: We assembled interdisciplinary focus groups to discuss areas for improvement in the discharge process of BPD infants with supplemental oxygen. Based on this, we established a “SAFER” Discharge Criteria, consisting of 5 components: S – See patient; pulmonology consult prior to discharge, A – Action Plan; emergency contact information provided for respiratory concerns, F – Follow up visit with pulmonology scheduled prior to discharge, E – Education for oxygen equipment, and R – Repeat chest x-ray prior to discharge. We conducted retrospective data collection by reviewing NICU discharge encounters over a 33-month period. Our primary measure was percentage of BPD discharges meeting ≥ 4 of 5 criteria.

We implemented interventions via PDSA cycles, then performed chart reviews to assess for changes in the percentage of SAFER discharges. One intervention involved the creation of BPD Discharge Guidelines, an educational checklist to ensure patient stability prior to discharge and reduce variation in consultant recommendations. Other interventions standardized parent education to reduce inconsistencies with equipment and improve parental understanding.


Results: Baseline data showed an average of 6% SAFER discharges from January to December 2020 and 13% SAFER discharges from January to December 2021. Our interventions began in January 2022. By September 2022, we saw an increase in SAFER discharges to average of 54% over a 9-month period. Secondary measures included timing of initial pulmonary consult (improved from 4.25 days to 22 days prior to discharge) and average timing of pulmonary follow up after discharge (improved from 44.6 days to 22.6 days following discharge).

Conclusion(s): A standardized approach to discharge is a promising method for reducing inconsistencies and increasing safety for complex BPD infants who are transitioning home from the NICU.