Neonatal Intensive Care Unit to Home Discharge Communication: A Quality Improvement Project.

ABSTRACT

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. Methods: 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. Results: 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. Conclusion: 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.