Systematic Changes to Help Parentsof Medically Complex Infants Manage Medical Expenses.

BACKGROUND: Financial obligations serve as an added source of stress and burden for parents of medically complex infants that have extended hospitalizations in the neonatal intensive care unit. Financial resources and support personnel are available to assist parents, but systems must be in place to help access these services. When neonatal intensive care unit nurses work collaboratively with financial support personnel, they improve families' access to financial resources. PURPOSE: The purpose of this quality improvement initiative was to increase and facilitate timely parent referrals to health benefits coordinators (HBCs). METHODS/SEARCH STRATEGY: Utilizing the Plan-Do-Study Act framework, the hospital's current system for HBC referrals was revised utilizing 3 Plan-Do-Study Act cycles. FINDINGS/RESULTS: A substantial increase in the percentage of HBC referrals, from preimplementation of less than 5% to a sustained average of 90% was observed. IMPLICATIONS FOR PRACTICE: A simple, sustainable screening process was successfully created to identify families with primary health insurance who qualified for coordination of benefits. This resulted in a significant increase in the number of HBC referrals. Minimal time is now required for the multidisciplinary team to ensure that parents, eligible for referral, are identified as soon as possible. Early identification and timely referral to the HBC may lessen the financial burden for families caring for children with medically complex long-term care needs by securing secondary insurance and other resources. IMPLICATIONS FOR RESEARCH: Research focused on the financial impact of the HBC role is needed.

Improving rates of ferrous sulfate prescription for suspected iron deficiency anaemia in infants.

BACKGROUND: Iron deficiency anaemia (IDA) in infancy is prevalent and associated with impaired neurodevelopment; however, studies suggest that treatment and follow-up rates are poor. OBJECTIVES: To improve the rate of ferrous sulfate prescription for suspected IDA among infants aged 8-13 months to 75% or greater within 24 months. METHODS: We implemented a multidisciplinary process improvement effort aimed at standardising treatment for suspected IDA at two academic paediatric primary care clinics. We developed a clinical pathway with screening and treatment recommendations, followed by multiple plan-do-study-act cycles including provider education, targeted reminders when ferrous sulfate was not prescribed and development of standardised procedures for responding to abnormal lab values. We tracked prescription and screening rates using statistical process control charts. In post hoc analyses, we examined rates of haemoglobin (Hgb) recheck and normalisation for the preintervention versus postintervention groups. RESULTS: The prescription rate for suspected IDA increased from 41% to 78% following implementation of the intervention. Common reasons for treatment failure included prescription of a multivitamin instead of ferrous sulfate, and Hgb not flagged as low by the electronic medical record. Screening rates remained stable at 89%. Forty-one per cent of patients with anaemia in the preintervention group had their Hgb rechecked within 6 months, compared with 56% in the postintervention group (p<0.001). Furthermore, 30% of patients with anaemia in the postintervention group had normalised their Hgb by 6 months, compared with 20% in the preintervention group (p<0.05). CONCLUSIONS: A multipronged interdisciplinary quality improvement intervention enabled: (1) development of standardised practices for treating suspected IDA among infants aged 8-13 months, (2) improvement of prescription rates and (3) maintenance of high screening rates. Rates of Hgb recheck and normalisation also increased in the intervention period.​.