202 - A QI Project to Decrease Suboptimal Patient Transfers from the NICU to the Special Care Nursery (SCN)

Poster Number: 202
Publication Number: 202.126

Kiane A. Douglas, Brody School of Medicine at East Carolina University, Greenville, NC, United States; chinonye eriobu, Brody School of Medicine at East Carolina University, winterville, NC, United States; Ann Sanderson, Vidant Medical Center, Greenville, NC, United States; Kelly Allis, University of North Carolina children’s Hospital, Louisburg, NC, United States; Dmitry Tumin, Brody School of Medicine at East Carolina University, Greenville, NC, United States; Uduak Akpan, Brody School of Medicine at East Carolina University, Greenville, NC, United States

Background: •Transitions of care are a critical part of a patient’s hospital course
•When not done optimally, could lead to medical errors or near misses, interrupt continuity of care and decrease patient safety.
•In our Neonatal Intensive Care Unit (NICU) we noticed several problems with NICU to Special Care Nursery (SCN) transfers, thus a QI project was designed to improve the transfer process.

Objective: Decrease the rate of suboptimal transfers from the NICU to the SCN by 50% in 9 months *Suboptimal transfers are defined by discharge of a patient within 72 hours of being transferred from the NICU to the SCN or patient returning to the NICU within 5 days of transfer.

Design/Methods: A multidisciplinary team consisting of an attending neonatologist, neonatology fellow, SCN nurse practitioner, NICU and SCN charge nurses, and a medical student was formed to work on the QI project. Initial steps included collecting baseline data with an initial staff survey to determine opinions of the transfer process. Interventions included surveys at the beginning, middle and end of the project, implementation of a transfer checklist, and design and implementation of an algorithm. Three PDSA cycles were used to evaluate improvement and develop further interventions.
•PDSA cycle 1: Transfer checklist was developed. Initial staff survey completed.
•In PDSA cycle 2: Transfer algorithm implemented. Second staff survey completed.
•In PDSA 3: The checklist and algorithm were modified. Final staff survey was completed.
Outcome measures:
•Percentage of patients discharged from the hospital within 72 hours of transfer or returned to the NICU within 5 days of transfer
•Percentage of parents notified before transfer (goal: 95%)
Process measures:
•Percentage of patients with a completed transfer checklist
•Percentage of staff that report satisfaction with the process (Goal: 30%)
Balancing measures:
•Percentage of providers

Results: Initial survey responses showed that staff believed there was lack of a well-defined transfer process, lack of a designated person responsible for transfer decisions, and no consistency in parent notification prior to transfers. At the end of the improvement period, parent notification rate and staff satisfaction were significantly improved.Conclusion(s): The lack of a standard process for these transfers allow room for medical error and provider and patient/family dissatisfaction. It was determined that a well-defined process for transfers was needed and would improve patient care and safety. Next steps for this QI project include monitoring for sustainability over a 6-month period.
K Douglas CVBSOM CV resume KDouglas updated dec 2021.pdf
p Chart showing parent notification rate