221 - Implementation of a new discharge planning pathway in Neonatal Intensive Care Unit (NICU) to improve parent readiness and satisfaction scores: A single center Quality Improvement (QI) process

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 221
Publication Number: 221.441

Lalitha Gundamraj, Michigan State University College of Human Medicine, Lansing, MI, United States; Said Omar, Michigan State University College of Human Medicine, Lansing, MI, United States

Presenting Author(s)

Lalitha Gundamraj, MD (she/her/hers)

Assistant Professor
Michigan State University College of Human Medicine
Lansing, Michigan, United States

Background: The lack of proper preparation prior to discharge of an infant from Neonatal Intensive Care Unit (NICU) can potentially lead to parental stress and mistrust in physicians and health care system. NICU teams should consider feedback from parent satisfaction surveys completed prior to discharge. NICU teams need to improve the processes involving discharge of an infant from NICU to improve parental preparation and satisfaction.

Objective:

A QI team was formed with nursing management member and neonatologist. All factors causing delays in discharge order placement were recognized. Separate consensus-based algorithms were developed for infants with short and long hospitalization. The specific aim was to place the discharge order by 11 am, except for unforeseeable social and parental factors that could lead to late discharge.

Design/Methods:

A late order was defined as discharge order placed after 11am. The total number of discharges and timing of order placement over a four-month period were collected prior to this project. All the causes of delay were examined and divided into "medical", "nursing" and "uncontrolled" factors. This allowed us to focus on each individual reason behind a delayed order placement or delayed infant’s discharge. Short and long stay algorithms (fig 1 and 2) were prepared, shared with medical, nursing teams and feedbacks were incorporated. To better prepare parents for discharge, two documents of "what to expect" were prepared. First form was given to parents at admission and second form when an "expected date of discharge" is determined by medical team. These forms detailed general information regarding NICU stay, and goals needed to be met prior to discharge including parent education, infant health changes, nursing led education and preparedness for home as well as follow up planning. Nursing skill workshops and medical team orientation was completed. We collected data for six months following implementation of this QI project.

Results: After implementation of the QI processes, the average percent of discharge order placement after 11am was significantly decreased from 62.75% to 20% with p-value < 0.001(fig 3). The most common reasons for the delay were "uncontrolled" factors. We continue to collect data to provide feedback to teams, sustain results and improve further

Conclusion(s): Every NICU should evaluate their processes to develop a consistent practice along with preparation of parents for discharge starting at admission. Our experience has led to reducing unnecessary time spent in the NICU and improved parental trust and satisfaction