Published online November 1, 2006
PEDIATRICS Vol. 118 Supplement November 2006, pp. S124-S133 (doi:10.1542/peds.2006-0913I)

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ARTICLE

Implementation and Case-Study Results of Potentially Better Practices to Improve the Discharge Process in the Neonatal Intensive Care Unit

Marla M. Mills, RN, CNP^a, Debra C. Sims, RNC^b, Jack Jacob, MD^c

^a Neonatal Intensive Care Unit, University of Minnesota Children's Hospital, Fairview, Minneapolis, Minnesota
^b Neonatal Intensive Care Unit
^c Alaska Neonatology/Pediatrix Medical Group, The Children's Hospital at Providence, Anchorage, Alaska

Objective. The objective of this study was to implement potentially better practices for discharge planning in the NICU.

Methods. Each participating hospital completed a self-assessment tool on discharge planning and a staff satisfaction survey. Parent satisfaction data were obtained from an Internet-based survey. Many projects regarding discharge planning were completed at each participating center. A major emphasis was the development of transition points to span discharge planning over the entire hospitalization. Results of compliance with tasks or processes that were identified by the transition points and results of staff and parent satisfaction surveys were monitored over time.

Results. The implementation of the transition points at each center demonstrated an improvement in the completion of discharge tasks within the recommended time frame. Combined results of all centers demonstrated a moderate improvement in compliance with transition points from baseline to final measurement in the following areas: unit orientation (56%–81%), identification of a parent feeding plan (74%–92%), completion of cardiopulmonary resuscitation training (55%–72%), and car seat education (42%–63%). Staff survey results showed improvement from baseline to final measurement in the following areas: staff satisfaction with the discharge process (32%–50%), clear documentation of the discharge plan (26%–40%), and clarity of team members' roles in the discharge process (24%–44%). A resource kit on discharge planning was developed for staff and included a section with parent education material. An Internet-based parent satisfaction survey was implemented successfully.

Conclusions. All centers that participated in the collaborative made significant strides in the discharge planning process. Overall, parent satisfaction with discharge planning was high, and improvements were noted in staff satisfaction and availability of resource material.

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Key Words: discharge planning • potentially better practice • neonatal intensive care

Abbreviations: VON—Vermont Oxford Network • PBP—potentially better practice • PDSA—plan-do-study-act • NPLH—No Place Like Home • EI—early intervention

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Accepted Jul 18, 2006.

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