Douglas Kiane A, Eriobu Chinonye, Sanderson Ann, Tumin Dmitry, Akpan Uduak S
Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, N.C.
Division of Neonatology, ECU Health Medical Center, Greenville, N.C.
Pediatr Qual Saf. 2023 Feb 13;8(1):e635. doi: 10.1097/pq9.0000000000000635. eCollection 2023 Jan-Feb.
Poorly executed transitions of care in health care systems are associated with safety concerns and patient dissatisfaction. We noticed several problems in the transfer process between our neonatal intensive care unit (NICU) and special care nursery (SCN) and designed this quality improvement project to address them. The aim was to decrease suboptimal transfers from the NICU to the SCN by 50% over 9 months. We defined suboptimal transfers as the discharge of a patient within 3 days of transfer from the NICU to the SCN or the return of a patient to the NICU within 5 days of the transfer.
We formed a multidisciplinary team and collected baseline data from October 2019 to December 2020. Major interventions included implementing a transfer checklist and algorithm. We utilized 3 staff surveys to evaluate the progress of the project. We used statistical process control charts to track project measures over time.
Patient demographics and SCN length of stay were similar for the baseline and postintervention periods. We decreased suboptimal transfers over 21 months (January 2021 to September 2022), achieved a significantly increased rate of parent notification before transfers (81% baseline versus 93% postintervention), and increased staff satisfaction with the transfer process (15% baseline versus 43% postintervention).
We successfully improved the transfer process from our NICU to the SCN via a quality improvement project. Increased staff satisfaction and the lack of perception of additional burden to the staff from the new process are expected to sustain our results.
医疗保健系统中护理过渡执行不当与安全问题及患者不满相关。我们注意到新生儿重症监护病房（NICU）和特殊护理病房（SCN）之间的转诊过程存在若干问题，并设计了此质量改进项目来解决这些问题。目标是在9个月内将从NICU到SCN的次优转诊减少50%。我们将次优转诊定义为患者从NICU转至SCN后3天内出院，或转诊后5天内返回NICU。
我们组建了一个多学科团队，并收集了2019年10月至2020年12月的基线数据。主要干预措施包括实施转诊清单和算法。我们利用3次员工调查来评估项目进展。我们使用统计过程控制图来跟踪项目指标随时间的变化。
基线期和干预后期的患者人口统计学特征及SCN住院时间相似。我们在21个月（2021年1月至2022年9月）内减少了次优转诊，转诊前家长通知率显著提高（基线期为81%，干预后期为93%），员工对转诊过程的满意度也有所提高（基线期为15%，干预后期为43%）。
我们通过质量改进项目成功改善了从NICU到SCN的转诊过程。员工满意度提高，且员工认为新流程未增加额外负担，预计这些将维持我们的成果。
