175 - Establishing Potential Best Practices for Discharge from Regional Children’s Hospital NICUs: A Modified Delphi Study

Poster Number: 175
Publication Number: 175.234

Stephanie L. Bourque, University of Colorado School of Medicine, Greenwood Village, CO, United States; Kerri Machut, Northwestern University The Feinberg School of Medicine, Evanston, IL, United States; John Chuo, University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, PA, United States; Susan Cohen, Medical College of Wisconsin, Milwaukee, WI, United States; Yvette R. Johnson, Texas Christian University-University of North Texas Medical School, Westworth Village, TX, United States; Sharmila Nanda, UPMC Childrens Hospital of Pittsburgh, Morgantown, WV, United States; Laura H. Rubinos, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Rachel Ponzek, Childrens Hospital of Philadelphia, Philadelphia, PA, United States

Background: Lack of discharge preparedness following a prolonged neonatal intensive care unit (NICU) hospitalization is associated with an increased risk of readmission and higher levels of parental stress. The absence of consensus guidelines regarding discharge, particularly from NICUs at regional children’s hospitals, has led to wide inter-institutional practice variability and differential rates of health utilization following discharge. Infants with complex medical needs would benefit from a systematic approach in ensuring a safe transition to home.

Objective: To establish multi-center and inter-disciplinary consensus guidelines for discharge preparation for infants in regional children’s hospital NICUs.

Design/Methods: As the Children’s Hospital Neonatal Consortium Transitions of Care focus group, we conducted a systematic literature review, obtained input from our parent advisory board, and utilized quality improvement methodology including fish bone and key driver diagrams, yielding 52 potential best practice statements for discharge preparation. We identified key stakeholders across the neonatal and outpatient continuum including parents, neonatal, pediatric, and ancillary providers. Using the modified Delphi method, we surveyed 131 stakeholders from 15 institutions on their level of agreement for the statement to be included in the final guideline regarding the discharge process and parental education. Consensus was defined at 85% agreement among respondents.

Results: Overall response rate was 46% (Table 1). Following two iterative modified Delphi method surveys (Figure 1), a total of 50 of the 52 statements met the predefined criteria for consensus. The clinical statements were grouped in the following sub domains: Process: medical readiness, family support, discharge tasks, staff optimization, discharge handoff, and post-discharge care; Education: tools for family education, staff optimization for education, and educational content (inpatient and outpatient). The top 10 consensus statements by domain are presented in Table 2.Conclusion(s): This multi-center and inter-disciplinary expert panel reached consensus on multiple potential best practices for complex discharge preparation from regional children’s hospital NICUs. These practices have the potential to make transition to home safer and more effective. Out next step will determine Donabedian factors that influence how a NICU might prioritize and implement these practices.
Table 1 – Stakeholder Respondent Demographics
Figure 1 – Modified Delphi Survey Results by Domain