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Improving the Discharge Process for Opioid-Exposed Neonates
Travis W Crook1,2,3, Erin K Munn4, Theresa A Scott4,5,6
1Departments of Pediatrics and travis.w.crook@vumc.org.
Insights
Improving care for opioid-exposed neonates (OENs) is crucial. A standardized discharge bundle significantly increased the completion rate of essential outpatient referrals, enhancing post-discharge support for these vulnerable infants.
Area of Science:
- Neonatal care
- Public health initiatives
- Healthcare quality improvement
Background:
- Opioid-exposed neonates (OENs) face significant risks of postdischarge complications.
- Effective connection to outpatient resources is vital for mitigating these risks.
- Existing discharge processes for OENs required improvement to ensure comprehensive care.
Purpose of the Study:
- To enhance the completion rate of a standardized discharge bundle for OENs.
- To improve the connection of OENs to essential outpatient services post-discharge.
- To reduce postdischarge complications in OENs through improved care coordination.
Main Methods:
- Implementation of the 'Team Hope' initiative, a hospital-wide program focused on OEN care.
- Development and application of a standardized discharge bundle including referrals to primary care, early intervention, home nursing, development clinic, and specialized clinics.
- Utilizing statistical process control charts to monitor the discharge bundle completion rate over time.
- Employing targeted interventions such as provider education, EHR reminders, and physician reminders.
Main Results:
- Initial discharge bundle completion rate was 2.6% before intervention.
- Following implementation of the standardized bundle and interventions, the completion rate increased to 60.3%.
- Specific elements like early intervention and development clinic referrals showed significant improvement.
- The study analyzed data from 119 OENs, with 83 included in the post-intervention analysis.
Conclusions:
- A standardized discharge bundle effectively improved discharge processes for OENs.
- The implemented interventions successfully increased the rate of complete discharge bundles.
- This approach enhances the continuity of care and support for OENs after hospital discharge.
Objectives:
Opioid-exposed neonates (OENs) are a population at risk for postdischarge complications. Our objective was to improve completion of a discharge bundle to connect patients with outpatient resources to mitigate postdischarge risks.
Methods:
Team Hope, a hospital-wide initiative to improve the care of OENs, examined the completion of a discharge bundle from September 2017 through February 2019. A complete discharge bundle was defined as referral to a primary care physician, referral to early intervention services, referral to in-home nursing assessment and educational services, referral to the development clinic if diagnosed with neonatal abstinence syndrome, and referral to the gastroenterology or infectious disease clinic if exposed to hepatitis C virus. After obtaining baseline data, simple interventions were employed as education of providers, social workers, and case management; reminder notes in the electronic health record; and biweekly reminders to resident physicians. A statistical process control chart was used to analyze our primary measure, with special cause variation resulting in a shift indicated by 8 consecutive points above or below the mean line.
Results:
One hundred nineteen OENs were examined with an initial discharge bundle completion of 2.6% preimplementation. Referral to early intervention services and the development clinic were the least successfully completed elements before intervention implementation. After the development of the discharge bundle in July 2018, special cause variation was achieved, resulting in a mean-line shift with 60.3% now having a complete bundle for 83 OENs.
Conclusions:
We implemented a standardized discharge bundle that improved our discharge processes for OENs.
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