Improving Outcomes through a Neonatal Abstinence Syndrome Collaborative in Maryland

Area of Science:

• Neonatal care
• Quality improvement initiatives
• Public health

Background:

• Neonatal Abstinence Syndrome (NAS) poses significant challenges in perinatal care.
• Effective management strategies are crucial to improve infant outcomes and reduce healthcare burdens.
• Statewide collaboratives offer a framework for standardizing and enhancing care for vulnerable newborns.

Purpose of the Study:

• To implement and evaluate a statewide quality improvement collaborative for Neonatal Abstinence Syndrome (NAS) in Maryland.
• To reduce hospital length of stay (LOS), interhospital transfers, and 30-day readmission rates for infants with NAS.
• To disseminate best practices and standardized educational curricula for NAS care among birthing hospitals.

Main Methods:

• A statewide collaborative involving 31 of 32 Maryland delivery hospitals and one specialty pediatric hospital.
• Development and implementation of a best practice bundle for NAS care, utilizing the Vermont Oxford Network (VON) NAS toolkit.
• Provision of standardized NAS educational curriculum to healthcare staff and audits of policy implementation over a 2-year period (Q4 2016 - Q4 2018).

Main Results:

• A nonsignificant reduction of 1.5 days in mean and median LOS was observed among term infants with NAS and hospital stays exceeding 5 days.
• A significant reduction in interhospital transfers for infants with NAS, decreasing from 20.1% in 2016 to 11.0% in 2018.
• The collaborative successfully engaged 97% of delivery hospitals in education and care standardization.

Conclusions:

• The implemented best practice bundle was associated with a significant reduction in interhospital transfers for infants with NAS, mitigating family disruption.
• The statewide collaborative model proved effective in standardizing NAS care and engaging a high percentage of participating hospitals.
• While LOS showed a nonsignificant trend towards reduction, the substantial decrease in interhospital transfers represents a unique and valuable outcome.