Implementing the Eat, Sleep, Console (ESC) Model in a Small Safety-Net Hospital: A Phased Quality Improvement...

The rising prevalence of opioid use during pregnancy has contributed to increasing rates of neonatal opioid withdrawal syndrome (NOWS). Traditional management using the Finnegan Neonatal Abstinence Scoring System (FNASS) is associated with prolonged hospitalization, increased neonatal intensive care unit (NICU) utilization, and reduced maternal‑infant bonding. Function‑based models such as Eat, Sleep, Console (ESC) emphasize non‑pharmacologic care and may improve outcomes. This project aimed to transition from FNASS to ESC within a small safety‑net hospital and evaluate associated clinical outcomes.

We conducted a single‑center quality improvement initiative using a phased implementation strategy over 2.5 years. Eligible neonates were >36 weeks gestation or >2000 grams with prenatal opioid exposure. Clinical outcomes were compared between infants managed with FNASS (n=24) and ESC (n=12). Due to the small sample size and skewed distributions, continuous variables were analyzed using Mann-Whitney U tests and reported as medians with interquartile ranges.

ESC implementation was associated with shorter median length of stay (3.5 vs. 16.5 days; p<0.001), fewer days on pharmacologic treatment (0 vs. 11.5 days; p=0.008), and fewer days in the NICU (0 vs. 13.5 days; p<0.001). Infants in the ESC group spent a higher percentage of hospitalization bonding with their mothers (100% vs. 14.6%; p=0.002), although the total number of bonding days did not differ significantly (p=0.199). Pharmacologic treatment use was lower in the ESC group (0% vs. 54.2%; p=0.002).

Transitioning to ESC was associated with reduced pharmacologic treatment, shorter hospitalization, decreased NICU utilization, and improved maternal‑infant bonding. These findings support the feasibility of ESC implementation in resource‑limited safety‑net settings and highlight a scalable framework for equitable NOWS care.