131 - Sustained reduction in length of stay for newborns affected by NOWS following implementation of Eat, Sleep, Console: 4-year results

Poster Number: 131
Publication Number: 131.415

Alison Sweeney, UNC Chapel Hill, Chapel Hill, NC, United States; Athena Samaras, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Ashley Sutton, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States

Background: The incidence of Neonatal Opioid Withdrawal Syndrome (NOWS) continues to rise and remains a significant source of health care utilization and morbidity for affected newborns. Many hospitals caring for newborns have recently implemented changes in managing NOWS including emphasis on non-pharmacologic care and transition from utilizing variations of the Finnegan Neonatal Abstinence Scoring System (FNASS) to the Eat, Sleep, Console (ESC) approach. Given the novel approach, little has been published about long-term sustainability of outcomes.

Objective: We aimed to reduce length of stay (LOS) in infants with in utero opioid exposure and assess the sustainability of these outcomes over 4 years. We secondarily aimed to reduce transfer from the mother-baby unity (MBU) to the inpatient floor for escalation of treatment by implementation of ESC in the MBU.

Design/Methods: We performed a longitudinal quality improvement intervention at our tertiary care hospital. Data were collected and analyzed by automated report utilizing presence of FNASS score documented during the baseline period (6/2016-10/2017) and search for the text order for ESC in the intervention periods (11/2017-7/2018) and 1/2020-11/2021).  Data were not accessible for the intervening 17 months, during the initial transition to ESC in the MBU. Included infants were confirmed by manual review of maternal chart to be opioid-exposed in the third trimester and were managed only in the MBU or on the floor. Key outcomes were monitored on statistical process control charts and interpreted with standard Shewhart rules.  At baseline we utilized FNASS in both care areas. Key interventions included transition to ESC on the inpatient floor (11/2017) and transition to ESC in the MBU (1/2019).

Results: LOS for infants at-risk for NOWS decreased from a baseline of 149 hours to 97 hours with floor transition to ESC (Figure 1). Data collection following MBU ESC implementation resumed shortly before the onset of the COVID-19 pandemic and LOS was 99 hours during this time. LOS subsequently decreased to 85 hours following eased pandemic-related restrictions, showing the effect of the MBU transition. Percent of infants discharged directly from the MBU increased from 59% to 79% following ESC implementation in the MBU.  Conclusion(s): Transition to ESC resulted in sustained reduction over 4 years in average length of stay and in decreased utilization of hospital resources by infants at risk of NOWS. Utilizing ESC in the MBU resulted in decreased need for transfer to the inpatient floor, promoting dyad cohesion and further decreased LOS for affected newborns.  
Figure 1. Length of Stay for Newborns at-Risk of Neonatal Opioid Withdrawal SyndromeNOWS- neonatal opioid withdrawal syndrome, ESC- Eat, Sleep, Console, MBU- Mother-Baby Unit