N. B. Hebballi1, M. A. Bartz-Kurycki1, K. C. Kelly1, E. I. Garcia1, J. K. Chica1, K. Tsao1, C. Aneji1, E. A. Hillman1, M. T. Austin1 1McGovern Medical School at UTHealth and Children’s Memorial Hermann Hospital,Department Of Pediatric Surgery,Houston, TX, USA
Introduction: Neonatal Intensive Care Unit (NICU) graduates often represent children with complex medical needs. Previously, we found that 22% of NICU graduates had at least one unplanned healthcare visit within 90 days of discharge, including emergency department visit, unplanned clinic visit and hospital readmissions. Given this high rate of unplanned healthcare utilization, we aimed to identify barriers to a successful transition from the NICU to home.
Methods: We conducted semi-structured interviews with 21 participants including 8 parents, 4 physicians, 7 nurses and 2 discharge coordinators to investigate their perceived barriers to a successful transition to home. We used Ishikawa (fishbone) diagram with fish’s head as the problem (infant’s readmission) and backbone of the fish listing out all barriers that contributed to the problem. Ishikawa diagram is a visualization tool used for categorizing the possible causes of a problem in order to identify its root causes. Potential barriers were categorized into policy, process, electronic health record (EHR)/hospital environment, information/material, healthcare providers and parents/families.
Results: A total of 32 barriers were identified across all the categories combined. The most barriers fell into the healthcare providers category (28%) followed by process (22%). Healthcare providers specified the following barriers: lack of a discharge checklist; lack of standardized discharge process and hand off process between NICU nurse and home health nurses; communication gap between physicians, NICU staff and parents; timing of discharge orders placements in the EHR; providers with varied level of experience; disconnect between inpatient and outpatient EHR systems and complex discharge related paperwork. Parents listed lack of DME training and comprehension at the hospital, no personalized infant care checklist/schedule for infant care at home, failure to identify pediatrician prior to discharge and information overload at the time of discharge as potential barriers.
Conclusion:The barriers identified were multifactorial and included lack of standardized discharge processes, poor communication and coordination among providers and parents, disconnect between EHR system and no formal parental training of DME. In addition to healthcare providers, parents are important stakeholders in caring for infants at home post NICU discharge and their perspective is crucial to successful transition to home of NICU graduates. We plan to use this information to help develop a transition to home program for parents of NICU graduates with the goal of reducing unplanned healthcare utilization following discharge.
