High Risk Follow-Up of NICU Graduates - A Quality Improvement Study at a Tertiary Care Centre

Area of Science:

• Neonatal care
• Quality improvement science
• Public health

Background:

• High-risk neonates require consistent follow-up for optimal development.
• Facility-based follow-up rates for high-risk infants are often suboptimal, particularly in resource-limited settings.
• Effective strategies are needed to improve adherence to scheduled follow-up visits.

Purpose of the Study:

• To enhance the facility-based follow-up rate for high-risk neonates.
• To improve attendance at the first visit and subsequent visits up to 24 months of age.
• To implement and evaluate low-cost interventions in a tertiary neonatal intensive care unit.

Main Methods:

• A quality improvement study was conducted in a tertiary neonatal intensive care unit.
• Interventions included structured pre-discharge counseling, voice call reminders, standard operating procedures, and integration with the District Early Intervention Center.
• Statistical process control charts monitored monthly follow-up rates through 12 months of age.

Main Results:

• Follow-up attendance improved significantly: first visit (38% to 100%), 1 month (36% to 79%), 4 months (32% to 62%), 8 months (26% to 48%), and 12 months (24% to 45%).
• Pre-discharge counseling rates increased to over 85%, and voice calls reached 79% of families.
• Video consultations facilitated assessment for 30-40% of missed visits, though staff transitions impacted consistency.

Conclusions:

• Multipronged, low-cost interventions can achieve substantial and sustained improvements in high-risk infant follow-up rates.
• These strategies are effective even in resource-limited public hospital settings.
• Systematic training is crucial to mitigate variations caused by staff transitions.