403 - Improving Developmental-Behavioral Follow-up Rates of NICU Graduates

Poster Number: 403
Publication Number: 403.436

Anupriya Bhatia, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Staten Island, NY, United States; Michele Dehnert, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Staten Island, NY, United States; Charmane Calilap-Bernardo, Cohen Children's Medical Center, Staten Island, NY, United States; Amanda Rahman, Staten Island University Hospital, Staten Island, NY, United States

Background: 8.3% of all live births are infants of low birth weight (LBW), and 10.2% are preterm. Preterm and LBW infants are at high risk for short and long-term complications, including poorer neurodevelopmental outcomes. Infants that receive earlier therapies and educational interventions have improved outcomes in cognition, behavior, and motor skills. However, rates of follow-up for the high-risk infant remains low. At Staten Island University Hospital (SIUH), infants at risk for neurodevelopmental complications are identified and referred to follow-up with the department of developmental-behavioral pediatrics (DBP). The goal of this quality improvement project is to increase overall follow-up at DBP appointments following discharge from the NICU.

Objective: Improve follow-up attendance rates with DBP for at-risk infants discharged from the NICU. Specifically, our goal is to increase attendance at initial DBP appointments from a baseline of 29.2% to 50% within 18 months.

Design/Methods: This quality improvement project is a collaboration with SIUH NICU and the department of DBP. To assess our primary SMART aim, a core multi-disciplinary team (NICU, DBP, pediatrics rehab, social work), identified multiple primary drivers to guide the success (Figure 1). Infants referred were based upon 14 pre-identified criterion. Our first PDSA cycle began on January 24, 2021. Multiple PDSA cycles continued, some simultaneously, based upon the primary drivers. To date, emphasis is on standardization of referrals, education of nursing and medical team, and education of parents (Figure 2).

Results: Demographic data is shown in Table 1. The mean gestational age of patients referred to date was 35.1 weeks. The most common reason for referral was prematurity ( < 35 weeks GA). Baseline data (2019) showed an attendance rate of the high-risk infant at the DBP clinic of 29.2%. 2020 data was excluded due to the Covid-19 epidemic. Through the PDSA cycles to date, there is an increase in appropriate referrals to above 95% and an overall increase in attendance to 54.7% to date.Conclusion(s): A multi-disciplinary approach has led to increased identification of infants who require follow-up with DBP and has led to an increase in attendance of the high-risk infant. Future directions include collaboration with community pediatricians, emphasis on retention of infants beyond one visit, and analysis of impact on long-term neurodevelopmental outcomes.
Figure 1Driver Diagram - Green boxes indicate steps performed; Yellow boxes indicate future steps to be taken
Figure 2Run Chart demonstrating 2021 Follow-Up Rates