404 - Outcomes of a Quality Improvement Project: Implementing Trauma Informed Care in a Neonatal Intensive Care Unit

Poster Number: 404
Publication Number: 404.436

Jennie Godwin, Children's Mercy Hospital Kansas City, Prairie Village, KS, United States; Patty Davis, Children's Mercy Hospitals and Clinics, Lake Lotawana, MO, United States; Christopher R. Nitkin, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Dena K. Hubbard, Childrens Mercy/University of Missouri-Kansas City, Kansas City, MO, United States

Background: The experience of being hospitalized in a Neonatal Intensive Care Unit (NICU) is recognized as a traumatic stressor to both the infants and their families. Physicians working in the NICU experience indirect traumatization and are at risk for burnout. Trauma Informed Care can increase effectiveness of healthcare delivery, ensure that staff, policies and procedures do not cause unintentional harm, promote staff resilience, and improve the overall quality of the patient experience.

Objective: To evaluate physician uptake and implementation of Trauma Informed Care (TIC) in a large Level IV NICU after providing comprehensive TIC education.

Design/Methods: The Plan Do Study Act method was used for this pre-post descriptive study. A NICU-specific TIC curriculum consisting of 10 one-hour sessions covering TIC awareness, sensitive practices, and resilience at work was developed and presented to Neonatology faculty and fellows at Children’s Mercy Hospital (CMH) over a 10-month period. Physicians completed the Attitudes Related to Trauma-Informed Care (ARTIC) survey before and after receiving TIC education. The ARTIC survey uses a bipolar Likert scale ranging 1 to 7 with higher scores being more favorable. Evaluations were completed after each session. After completion of the curriculum, each physician was surveyed about implementation of TIC in their everyday practice. In addition, ARTIC pre-surveys completed by physicians at CMH were compared to physicians nationally who are part of the American Academy of Pediatrics Section on Neonatal Perinatal Medicine (SoNPM).

Results: 37 physicians from CMH completed the ARTIC pre-survey with a mean score of 5.4 (SD 0.6). 267 physicians from SoNPM completed the ARTIC survey with a mean score of 5.6 (SD 0.6). 9 physicians from CMH completed the ARTIC post-survey with a mean score of 5.6 (SD 0.3). Evaluations addressing knowledge gained from each session scored an average of 4.4 (maximum score 5). 87% (27) of CMH physicians completed the survey about implementation of TIC into their everyday practice. Of these, 93% (25) answered positively describing practice changes that incorporate trauma informed principles. 7% (2) stated the education did not change the way they practiced, but provided evidence and structure to reinforce current practices.Conclusion(s): Providing comprehensive TIC education to physicians at a Level IV NICU is feasible and increased uptake and implementation of trauma informed practices. Next steps include creating online modules to make education accessible for new faculty and standardizing TIC practices.