Pattnaik Priyam, Nafday Suhas, Angert Robert
From the Department of Pediatrics, Division of Neonatology, Connecticut Children's Medical Center, Hartford, Conn.
Department of Pediatrics, Division of Neonatology, The Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, N.Y.
Pediatr Qual Saf. 2023 Jul 10;8(4):e669. doi: 10.1097/pq9.0000000000000669. eCollection 2023 Jul-Aug.
Neonatal intensive care unit (NICU) graduates require complex services after discharge. The NICU discharge process at Children's Hospital at Montefiore-Weiler, Bronx, NY (CHAM-Weiler) lacked a system for routine primary care provider (PCP) notification. Here, we describe a quality improvement project to improve communication with PCPs to ensure communication of critical information and plans.
We assembled a multidisciplinary team and collected baseline data on discharge communication frequency and quality. We used quality improvement tools to implement a higher-quality system. The outcome measure was the successful delivery of a standardized notification and discharge summary to a PCP. We collected qualitative data through multidisciplinary meetings and direct feedback. The balancing measures comprised additional time spent during the discharge process and relaying erroneous information. We used a run chart to track progress and drive change.
Baseline data indicated that 67% of PCPs did not receive notifications before discharge, and when PCPs did receive notifications, the discharge plans were unclear. PCP feedback led to proactive electronic communication and a standardized notification. The key driver diagram allowed the team to design interventions that led to sustainable change. After multiple Plan-Do-Study-Act cycles, delivery of electronic PCP notifications occurred more than 90% of the time. Surveys of pediatricians who received notifications indicated that the notifications were highly valued and aided in the transition of care for these at-risk patients.
A multidisciplinary team, including community pediatricians, was key to improving the rate of PCP notification of NICU discharge to more than 90% and transmitting higher-quality information.
新生儿重症监护病房（NICU）的毕业生出院后需要复杂的服务。纽约州布朗克斯区蒙特菲奥里 - 韦勒儿童医院（CHAM - 韦勒）的NICU出院流程缺乏向初级保健提供者（PCP）进行常规通知的系统。在此，我们描述一项质量改进项目，以改善与PCP的沟通，确保关键信息和计划的传达。
我们组建了一个多学科团队，并收集了关于出院沟通频率和质量的基线数据。我们使用质量改进工具来实施一个更高质量的系统。结果指标是成功向PCP提供标准化通知和出院总结。我们通过多学科会议和直接反馈收集定性数据。平衡指标包括出院过程中额外花费的时间以及传递错误信息。我们使用运行图来跟踪进展并推动变革。
基线数据表明，67%的PCP在出院前未收到通知，并且当PCP确实收到通知时，出院计划并不明确。PCP的反馈促使了主动的电子通信和标准化通知。关键驱动因素图使团队能够设计出导致可持续变革的干预措施。经过多个计划 - 执行 - 研究 - 改进循环后，电子PCP通知的传递率超过了90%。对收到通知的儿科医生的调查表明，这些通知非常有价值，并有助于这些高危患者的护理过渡。
包括社区儿科医生在内的多学科团队是将NICU出院通知PCP的比率提高到90%以上并传递更高质量信息的关键。
