Feasibility and Acceptability of a Neonatal Project ECHO (NeoECHO) as a Dissemination and Implementation Strategy to Prevent Necrotizing Enterocolitis

Abstract

Background: Caregivers in the neonatal intensive care unit (NICU) often determine care practices in silos, although access to learning communities can improve quality. Project ECHO, a telehealth-delivered mentoring intervention, provides specialists' expertise but not in the NICU until now. Necrotizing enterocolitis (NEC) prevention and timely recognition is one area where specialist support and engaging with a learning community could improve outcomes. NEC-Zero is one care bundle that aims to improve care quality by providing tools to implement NEC prevention in family-engaged ways.Aims: To examine the feasibility and acceptability of NeoECHO to disseminate NEC-Zero education and describe the intentions of internal facilitators (IFs) and clinicians to initiate quality improvement changes.Methods: This was a convergent mixed-methods study. Our team delivered the first neonatal adaptation of Project ECHO called "NeoECHO" to leverage facilitation as an implementation strategy to disseminate NEC-Zero evidence and support practice change.Results: Six IFs and seven NICUs participated. All units and IFs that began the series finished it. Of the 261 session attendees, 206 (79%) study evaluations were completed. Of those who completed evaluations, 89 (100%) completed at least one session and 29 (33%) completed three or more. Satisfaction was high. Participants appreciated the engaged and accessible format to learn from experts using real case examples and didactic sessions. Individuals and IFs reported intentions to adopt evidence based on NeoECHO.Linking Evidence to Action: NeoECHO was an acceptable and feasible way to engage underresourced NICUs and share NEC-Zero evidence and tools. More research is needed to examine the impact of NeoECHO on care processes and patient outcomes.

Exploring Internal Facilitators' Experience With NeoECHO to Foster NEC Prevention and Timely Recognition Through the iPARIHS Lens

“…Enrolled NICUs participated in a telehealth-delivered intervention (ie, NeoECHO) designed to close gaps between evidence and practice translation. 14 NeoECHO's use of tele-facilitation provided dissemination of the NEC-Zero bundle and tools to a wide audience. NeoECHO was designed to offer quality improvement (QI) coaching, which may be less accessible to units with limited budgets and reduced participation in other QI collaboratives.…”

“…Enrolled NICUs participated in a telehealth-delivered intervention (ie, NeoECHO) designed to close gaps between evidence and practice translation 14. NeoECHO's use of tele-facilitation provided dissemination of the NEC-Zero bundle and tools to a wide audience.…”

“…Key roles also included group management, case study organization and presentation, attendance at each of the 6 NeoECHO sessions, and support translation of evidence in various environments. Specialized training (ie, orientation) was provided to each IF and is discussed in a previously published article 14. Orientation took place in person, or virtually, in small groups using verbal and written communication.…”

“…This article aims to present the perspectives of the IFs who participated in the NeoECHO project and examine how they align with the iPARIHS framework. This qualitative analysis is part of a larger convergent mixed-methods study designed to determine the feasibility and acceptability of NeoECHO as a dissemination tool within the neonatal context, obtaining perspective of those trained as the spokes in the NeoECHO model, and to determine effectiveness and intentions to initiate QI changes on a local level 14. Additional results of the feasibility study are published elsewhere 14.…”

“…Specialized training (ie, orientation) was provided to each IF and is discussed in a previously published article. 14 Orientation took place in person, or virtually, in small groups using verbal and written communication. Each member was provided a reference notebook to support the retention of materials covered during orientation.…”