Transitioning medically complex infants home: lessons learned from quality improvement efforts.

IF 2.4 3区医学 Q2 OBSTETRICS & GYNECOLOGY Journal of Perinatology Pub Date : 2024-12-14 DOI:10.1038/s41372-024-02189-7

Dan Benscoter, Kristin Voos, Christine L Schuler, Andrea J Hoberman, Heather C Kaplan, Pierce Kuhnell, Carole M Lannon

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Abstract

Objective: Decrease: 1) time from tracheostomy or gastrostomy tube placement to discharge home, and 2) avoidable readmissions within 7 days post-discharge, for medically complex infants.

Study design: Five neonatology units and representatives from Medicaid and Managed Care Organizations participated. Measures included length of stay (LOS) from surgery to discharge, readmissions, and time from surgery to identifying home nursing. We used statistical process control (SPC) methods and bivariate tests for post-hoc before-after comparisons.

Result: Among 421 infants, no avoidable readmissions occurred in the final 25 months. LOS and all-cause readmissions were unchanged (SPC). LOS changes were variable, ranging from -39.5 days (tracheostomy and ventilator) to +30.8 days (tracheostomy without ventilator) and not significant. Median time to identify home nursing was 70.1 days (range 2-428).

Conclusion: Although lack of skilled home nursing precluded improving transitions from NICU to home in medically complex infants, all avoidable readmissions were eliminated for 25 months.

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过渡医疗复杂的婴儿之家：从质量改进工作中吸取的教训。

目的：减少：1)从气管造口或胃造口置管到出院的时间，2)避免病情复杂的婴儿出院后7天内再入院。研究设计：五个新生儿单位和来自医疗补助和管理护理组织的代表参与。测量包括从手术到出院的住院时间（LOS），再入院，以及从手术到确定家庭护理的时间。我们使用统计过程控制（SPC）方法和双变量检验进行事后前后比较。结果：421例患儿在最后25个月内无可避免的再入院。LOS和全因再入院没有变化（SPC）。LOS变化不同，从-39.5天（气管造口术加呼吸机）到+30.8天（气管造口术不加呼吸机）不等，无统计学意义。识别居家护理的中位时间为70.1天（范围2-428天）。结论：虽然缺乏熟练的家庭护理阻碍了医学复杂婴儿从新生儿重症监护病房到家庭的改善过渡，但所有可避免的再入院都被消除了25个月。

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来源期刊

Journal of Perinatology 医学-妇产科学

CiteScore

5.40

自引率

6.90%

发文量

284

审稿时长

3-8 weeks

期刊介绍： The Journal of Perinatology provides members of the perinatal/neonatal healthcare team with original information pertinent to improving maternal/fetal and neonatal care. We publish peer-reviewed clinical research articles, state-of-the art reviews, comments, quality improvement reports, and letters to the editor. Articles published in the Journal of Perinatology embrace the full scope of the specialty, including clinical, professional, political, administrative and educational aspects. The Journal also explores legal and ethical issues, neonatal technology and product development. The Journal’s audience includes all those that participate in perinatal/neonatal care, including, but not limited to neonatologists, perinatologists, perinatal epidemiologists, pediatricians and pediatric subspecialists, surgeons, neonatal and perinatal nurses, respiratory therapists, pharmacists, social workers, dieticians, speech and hearing experts, other allied health professionals, as well as subspecialists who participate in patient care including radiologists, laboratory medicine and pathologists.