Transition Home of Neonatal Infant

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Transition Home of Neonatal Infant
Outcome with unknown metrics related to obstetric care

Background

While infant mortality has substantially decreased in the US, we still lag behind other wealthy nations, with a current infant death rate of 6.1 per 1,000 live births. The cause is multifactorial, but largely due to the high rate of preterm and very low birth weight (VLBW) births in the US compared to other developed countries.

While infant mortality rates are well described, very limited information on post-discharge infant mortality for preterm and VLBW infants suggests estimates ranging from 7.5 to 22.5 deaths per 1,000 discharged. Furthermore, it is well documented that health care resource utilization including rehospitalization, primary care visits, and specialty service needs is greatly increased in high-risk compared to healthy infants. Rehospitalization rates are as high as 50% for high-risk infants discharged from neonatal intensive care units (NICU). In addition, these patients often require frequent primary care (20–29 visits in first year) as well as specialist services (74%). Thus, the care of high-risk infants following discharge to home results in significant health care expenditures. It is estimated that the average health care costs for the first year of life after discharge to home are approximately $32,000 for preterm infants versus $3000 for full term infants.

We completed the data collection and analysis of all infants discharged NICU within the Memorial Hermann healthcare system over a 3-month period to determine the incidence of unplanned post-discharge healthcare utilization (unplanned clinic visits, emergency department visits and hospital readmissions) by these infants. We found that nearly one-quarter of our patients had at least one unplanned healthcare visit within 90 days of discharge and 8% required re-admission. We also created a model to predict those infants at greatest risk of unplanned healthcare visits after discharge to home from the NICU. In our patient population, minority race/ethnicity was the strongest predictor of unplanned healthcare visits after discharge. Other important contributing factors included the need for durable medical equipment (DME) at discharge, prior surgery, and other medical comorbidities.

The results of this work will enable us to identify infants at greatest risk and target them as we develop interventions to minimize healthcare utilization following discharge from the NICU, with the goal of keeping high risk infants at home and healthy.

Lessons learned at Memorial Hermann Healthcare System
Looking at the each of the Safer Culture enabling factors, we identified and learned from the following gaps, barriers and/or facilitators that have led to both success and failure:

1. Organizational Enabling Factors
   1. Leader commitment & prioritization of safety
      The Memorial Hermann System has made unplanned post discharge readmission a priority.
   2. Policies and resources for safety
      There are policies in place for scheduling discharges.
2. Group Enabling Factors
   1. Cohesion
   2. Psychological safety
3. Individual Enabling Factors
   1. Safety knowledge & skills
   2. Sense of control

Individual commitment & prioritization of safety