Maryland Patient Safety Center, Elkridge, Maryland.
Maryland Department of Health,Prevention and Health Promotion Administration, Maternal and Child Health Bureau, Baltimore, Maryland.
Am J Perinatol. 2024 May;41(S 01):e22-e29. doi: 10.1055/a-1817-5522. Epub 2022 Apr 5.
A statewide Maryland Perinatal Neonatal Quality Collaborative, facilitated by the Maryland Patient Safety Center (MPSC), identified the three specific, measurable, attainable, relevant, and time-limited (SMART) aims to improve outcomes of neonatal abstinence syndrome (NAS) care as follows: (1) to reduce hospital length of stay (LOS), (2) to reduce interhospital transfers, and (3) to reduce 30-day readmission rates of infants with NAS.
The Maryland collaborative developed a bundle of best practices for care of infants with NAS. MPSC partnered with Vermont Oxford Network (VON) to utilize the VON NAS toolkit and provided its standardized NAS educational curriculum to address the three objectives for participating birthing hospitals. Efforts began in quarter 4 (Q4) of 2016 and continued for 2 years. Thirty-one of Maryland's 32 delivery hospitals (97%) participated in the 2-year collaborative. Additionally, one specialty pediatric hospital with an NAS unit participated in the group learnings. Participating facilities implemented components of the MPSC NAS bundle and provided their staff caring for infants with NAS and their mothers access to the VON standardized educational curriculum. MPSC partnered with VON to conduct two audits of implementation of policies and procedures in Q1 of 2016 and Q3 of 2018. The Maryland Department of Health supplied quarterly aggregate hospital information on LOS, interhospital transfers, and 30-day readmissions of infants with a discharge diagnosis of the International Classification of Disease, 10th Revision (ICD-10), P96.1.
Among term infants with NAS with total hospital stay greater than 5 days, we observed a nonsignificant reduction in both mean and median LOS of 1.5 days. In this same group, the rate of interhospital transfers fell significantly from 20.1% in 2016 to 13.8 and 11.0% in 2017 and 2018, respectively.
The best practice bundle created by the Maryland collaborative was associated with a reduction in the percentage of infants with NAS who required interhospital transfer, thereby reducing family disruption.
· A state NAS collaborative engaged 97% of delivery hospitals in education and standardization of care.. · The collaborative witnessed a 1.5-day decrease in length of stay, similar to that observed in other state collaboratives.. · The unique outcome of our collaborative was a 50% decrease in the rate of interhospital transfer..
马里兰州围产期新生儿质量协作组织由马里兰州患者安全中心（MPSC）协助，确定了提高新生儿戒断综合征（NAS）护理结果的三个具体、可衡量、可实现、相关和有时限（SMART）目标，具体如下：（1）减少医院住院时间（LOS），（2）减少医院间转院，（3）减少患有 NAS 的婴儿 30 天再入院率。
马里兰协作组织为 NAS 婴儿护理制定了一套最佳护理方案。MPSC 与佛蒙特州牛津网络（VON）合作，利用 VON NAS 工具包并提供其标准化 NAS 教育课程，以解决参与分娩医院的三个目标。该计划于 2016 年第 4 季度（Q4）开始，并持续了 2 年。马里兰州 32 家分娩医院中的 31 家（97%）参与了为期 2 年的协作。此外，一家有 NAS 病房的专业儿科医院也参加了该小组的学习。参与的医疗机构实施了 MPSC NAS 方案的部分内容，并为照顾 NAS 婴儿及其母亲的工作人员提供了参与 VON 标准化教育课程的机会。MPSC 与 VON 合作，在 2016 年第一季度和 2018 年第三季度进行了两次政策和程序实施情况审核。马里兰州卫生署提供了每季度关于患有 ICD-10 编码 P96.1 出院诊断的婴儿的 LOS、医院间转院和 30 天再入院的汇总医院信息。
在总住院时间超过 5 天的患有 NAS 的足月婴儿中，我们观察到 LOS 的平均和中位数均减少了 1.5 天，但无显著意义。在同一组中，医院间转院率从 2016 年的 20.1%显著下降到 2017 年和 2018 年的 13.8%和 11.0%。
马里兰协作组织创建的最佳实践方案与减少需要医院间转院的 NAS 婴儿比例有关，从而减少了家庭破裂。
·马里兰州的一个 NAS 协作组织让 97%的分娩医院参与了教育和护理标准化。·协作组织见证了住院时间减少了 1.5 天，与其他州的协作组织观察到的结果相似。·我们协作组织的独特成果是医院间转院率降低了 50%。
