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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

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Summary

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.

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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.