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Transitioning medically complex infants home: lessons learned from quality improvement efforts

Dan Benscoter1,2, Kristin Voos3,4, Christine L Schuler2,5

  • 1Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Journal of Perinatology : Official Journal of the California Perinatal Association
|December 14, 2024
PubMed

Insights

This study aimed to reduce hospital discharge times and readmissions for medically complex infants. While avoidable readmissions were eliminated, challenges in securing skilled home nursing impacted overall discharge efficiency.

Area of Science:

  • Neonatal care
  • Healthcare quality improvement
  • Pediatric medicine

Background:

  • Medically complex infants often face prolonged hospital stays.
  • Transitions from Neonatal Intensive Care Units (NICUs) to home can be challenging.
  • Readmissions pose a significant burden on healthcare systems and families.

Purpose of the Study:

  • To decrease the time from tracheostomy or gastrostomy tube placement to home discharge.
  • To reduce avoidable readmissions within 7 days post-discharge for medically complex infants.

Main Methods:

  • A collaborative effort involving five neonatology units and healthcare payer representatives.
  • Utilized statistical process control (SPC) methods to monitor length of stay (LOS) and readmissions.
  • Tracked time from surgery to identification of home nursing support.

Main Results:

  • No avoidable readmissions occurred in the final 25 months of the study.
  • Length of stay (LOS) and all-cause readmissions remained statistically unchanged.
  • Median time to identify home nursing was 70.1 days, highlighting a significant bottleneck.

Conclusions:

  • Elimination of avoidable readmissions was achieved for a 25-month period.
  • Lack of skilled home nursing care hindered improvements in NICU to home transitions.
  • Further system-level interventions are needed to optimize discharge processes for vulnerable infants.
Abstract

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