Association of Neonatologist Continuity of Care and Short-Term Patient Outcomes

Machut, Kerri Z.; Datta, Ankur; Stoller, Jason Z.; Rao, Rakesh; Mathur, Amit M.; Grover, Theresa R.; Billimoria, Zeenia; Murthy, Karna

doi:10.1016/j.jpeds.2019.05.023

Cited by 8 publications

(10 citation statements)

References 29 publications

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“…A small qualitative study reported parents feeling distressed by the transfer of an infant to the NICU after birth and by the length of time they were separated from their infant and that even the transition from high-intensive to low-dependency care within the NICU is frightening for parents [30]. With respect to handoffs in the NICU, a recent study examining the impact of neonatologist continuity of care on short-term patient outcomes did not show any association between the number of neonatologist transitions and ventilator duration, oxygen use, blood stream infection, or urinary tract infections; however, similar to our results, they found that transitions were strikingly frequent [31]. We hypothesize that by focusing on implementation of evidence-based potentially better practices related to communication, teamwork, family integration, and standardization during transitions, we will be able to improve many of these important outcomes such as LOS, post-discharge healthcare utilization, family satisfaction, as well as key clinical outcomes.…”

Section: Discussionsupporting

confidence: 86%

Variability in the systems of care supporting critical neonatal intensive care unit transitions

et al. 2020

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Objective Assess practices supporting care transitions for infants and families in the neonatal intensive care unit (NICU) using a model of four key drivers: communication, teamwork, family integration, and standardization. Study design Single-day audit among NICUs in the Vermont Oxford Network Critical Transitions collaborative addressing policies and practices supporting the four key drivers during admission, discharge, shift-to-shift handoffs, within hospital transfers, and select changes in clinical status. Results Among 95 NICUs, the median hospital rate of audited policies in place addressing the four key drivers were 47% (inter-quartile range (IQR) 35-65%) for communication, 67% (IQR 33-83%) for teamwork, 50% (IQR 33-61%) for family integration, and 70% (IQR 56-85%) for standardization. Of the 2462 infants included, 1066 (43%) experienced ≥1 specified transition during the week prior to the audit. Conclusions We identified opportunities for improving NICU transitions in areas of communication, teamwork, family integration, and standardization.

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Section: Discussionsupporting

confidence: 86%

Variability in the systems of care supporting critical neonatal intensive care unit transitions

et al. 2020

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“…A continuity pulmonologist could establish longitudinal trust with families in the hospital that extends into the outpatient realm, leading to improved parental comfort and preparedness at home and reducing the risk of avoidable medical readmissions 26 . Strategies to achieve continuity in the current health system structure have not been extensively evaluated 27 ; however, some older models, such as assigning nurse‐physician pairs to share continuity with a family, do exist 28 . Evolving these models to address the often‐fragmented care of children facing home ventilation requires more study.…”

Section: Discussionmentioning

confidence: 99%

Parent perspectives on facilitating decision‐making around pediatric home ventilation

Jabre

Raisanen

Shipman

et al. 2021

Pediatric Pulmonology

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Rationale Deciding about pediatric home ventilation is exceptionally challenging for parents. Understanding the decision‐making needs of parents who made different choices for their children could inform clinician counseling that better supports parents’ diverse values and goals. Objectives To determine how clinicians can meet the decisional needs of parents considering home ventilation using a balanced sample of families who chose for or against intervention. Methods We conducted semi‐structured interviews of parents who chose for or against home ventilation for their child within the previous 5 years. Parents were recruited from three academic centers across the United States. Interviews focused on parent–clinician communication during decision‐making and how clinicians made the process easier or more difficult. Qualitative analysis was used to generate themes and identify key results. Results Thirty‐eight parents were interviewed; 20 chose for and 18 chose against home ventilation. Five themes described their perspectives on how clinicians can facilitate high‐quality decision‐making: demonstrating dedication to families, effectively managing the medical team, introducing the concept of home ventilation with intention, facilitating meaningful conversation about the treatment options, and supporting and respecting the family's decision. Conclusions High‐quality decision‐making around home ventilation depends on individual clinician actions and the complex operations of large academic settings. Strong working relationships with parents, collaborative alliances with colleagues, and appropriate delivery of key content can help meet the needs of parents considering invasive breathing supports for their children.

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“…[11][12][13][14] Evaluations, applications, and recognized benefits of COC are diverse and, in some instances, limited in scope. Studies examining patient outcomes related to continuity of attending physicians (defined as the same physician over time) in intensive care units (ICUs) show reduced central venous line utilization and increased nutritional delivery, 15,16 but show mixed results for length of stay (LOS), readmission, and mortality. [17][18][19][20] Few studies have focused on COC from neonatologists (hereafter referred to as neonatologist COC) of infants in NICUs.…”

mentioning

confidence: 99%

“…[17][18][19][20] Few studies have focused on COC from neonatologists (hereafter referred to as neonatologist COC) of infants in NICUs. 15,16 As these infants often have complex clinical needs, prolonged LOS (often many months), and multiple transitions of providers, 15,[21][22][23] neonatologist COC may be especially critical. Incoming providers may contribute new ideas to the care of infants, but also may introduce gaps in longitudinal assessments, plans, The impact of neonatologist COC on families is also plausible, but dedicated, formal study is lacking.…”

mentioning

confidence: 99%

“…Studies examining patient outcomes related to continuity of attending physicians (defined as the same physician over time) in intensive care units (ICUs) show reduced central venous line utilization and increased nutritional delivery,15,16 but show mixed results for length of stay (LOS), readmission, and mortality 17–20. Few studies have focused on COC from neonatologists (hereafter referred to as neonatologist COC) of infants in NICUs 15,16. As these infants often have complex clinical needs, prolonged LOS (often many months), and multiple transitions of providers,15,21–23 neonatologist COC may be especially critical.…”

mentioning

confidence: 99%

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Parental Perspectives on Neonatologist Continuity of Care

Machut¹,

Gilbart²,

Murthy³

et al. 2021

Advances in Neonatal Care

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Background: Continuity of care (COC) is highly regarded; however, data about benefits are mixed. Little is known about components, parental views, or the value COC may provide to neonatal intensive care unit (NICU) infants and families. Purpose: To describe parents' perspectives on definitions, reasons they value, and suggested improvements regarding COC provided by neonatologists. Methods: We performed a qualitative study of in-person, semistructured interviews with parents of NICU infants hospitalized for 28 days or more. We analyzed interview transcripts using content analysis, identifying codes of parental experiences, expressed value, and improvement ideas related to neonatologist COC, and categorizing emerging themes. Results: Fifteen families (15 mothers and 2 fathers) described 4 themes about COC: (1) longitudinal neonatologists: gaining experience with infants and building relationships with parents over time; (2) background knowledge: knowing infants' clinical history and current condition; (3) care plans: establishing patient-centered goals and management plans; and (4) communication: demonstrating consistent communication and messaging. Parents described benefits of COC as decreasing knowledge gaps, advancing clinical progress, and decreasing parental stress. Suggested improvement strategies included optimizing staffing and sign-out/transition processes, utilizing clinical guidelines, and enhancing communication. Using parent input and existing literature, we developed a definition and conceptual framework of COC. Implications for Practice: NICUs should promote practices that enhance COC. Parental suggestions can help direct improvement efforts. Implications for Research: Our COC definition and conceptual framework can guide development of research and quality improvement projects. Future studies should investigate nursing perspectives on NICU COC and the impact of COC on infant and family outcomes.

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Association of Neonatologist Continuity of Care and Short-Term Patient Outcomes

Cited by 8 publications

References 29 publications

Variability in the systems of care supporting critical neonatal intensive care unit transitions

Variability in the systems of care supporting critical neonatal intensive care unit transitions

Parent perspectives on facilitating decision‐making around pediatric home ventilation

Parental Perspectives on Neonatologist Continuity of Care

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