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Statewide Needs Assessment of Neonatal Readiness at Delivery Hospitals in Maine
Leah Marie Seften1, Anya Cutler2, Jay Kerecman3
1The Barbara Bush Children's Hospital Scholars Academy at Maine Medical Center, Portland, Maine.
Background And Objective:
Neonatal mortality is higher in hospitals with low birth rates, and in Maine, two-thirds of birthing hospitals deliver less than 1 baby each day. Our objective was to characterize neonatal readiness at all Maine birthing hospitals and to identify barriers to and resources for improving care.
Methods:
We used a descriptive survey in which hospital leaders completed a 226-question survey followed by a virtual site meeting for data quality assurance. The survey we developed assessed hospital demographics and services, personnel, training, leadership, quality improvement, policies, transport/disaster preparedness, equipment, and barriers to and resources for improving neonatal care. The survey was adapted from existing assessments used for leveling of care and pediatric readiness. Data were analyzed using descriptive statistics, stratified by state-designated level of care I-IV.
Results:
From May 2022 to September 2023, all hospitals (N = 23) completed the survey and interview: 18 level I, 3 level II, 1 level III, and 1 level IV. Only 4 hospitals (17%) have on-site pediatricians and 3 (13%) have on-site obstetricians. All level I/II hospitals have access to specialists via phone consultation, whereas only 30% have telemedicine access to neonatology. A total of 87%, 74%, 61%, and 22% require Neonatal Resuscitation Program certification for physicians, nurses, respiratory therapists, and advanced practice clinicians who staff deliveries, respectively. Site-level qualitative data emphasized the need for additional resources and protected time to plan and implement training.
Conclusion:
Level I/II hospitals need support in accessing critical resources, both physical resources and pathways for accessing neonatal specialists, including appropriate equipment and increasing the availability of teleconsultations. Educational and clinical support is needed to improve neonatal readiness, which may help retain skilled clinicians and ensure quality of care at hospitals open for deliveries.
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