Improving infant outcomes through implementation of a family integrated care bundle including a parent supporting mobile application

Abstract

ObjectiveThe aim of the Integrated Family Delivered Care (IFDC) programme was to improve infant health outcomes and parent experience through education and competency-based training.DesignIn collaboration with veteran parents’ focus groups, we created an experienced co-designed care bundle including IFDC mobile application, which together with staff training programme comprised the IFDC programme. Infant outcomes were compared with retrospective controls in a prepost intervention analysis.Main outcome measuresThe primary outcome measure was the length of stay (LOS).ResultsBetween April 2017 and May 2018, 89 families were recruited; 37 infants completed their entire care episode in our units with a minimum LOS >14 days. From a gestational age (GA) and birth weight-matched retrospective cohort, 57 control infants were selected. Data were also analysed for subgroup under 30 weeks GA (n=20).Infants in the IFDC group were discharged earlier: median corrected GA (36+0 (IQR 35+0–38+0) vs 37+1 (IQR 36+3–38+4) weeks; p=0.003), with shorter median LOS (41 (32–63) vs 55 (41–73) days; p=0.022). This was also evident in the subgroup <30 weeks GA (61 (39–82) vs 76 (68–84) days; p=0.035). Special care days were significantly lower in the IFDC group (30 (21–41) vs 40 (31–46); p=0.006). The subgroup of infants (<30 weeks) reached full suck feeding earlier (median: 47 (37–76) vs 72 (66–82) days; p=0.006).ConclusionThis is the first reported study from a UK tertiary neonatal unit demonstrating significant benefits of family integrated care programme. The IFDC programme has significantly reduced LOS, resulted in the earlier achievement of full enteral and suck feeds.

Comparison of family centered care with family integrated care and mobile technology (mFICare) on preterm infant and family outcomes: a multi-site quasi-experimental clinical trial protocol

“…Of note, the FICare protocol in this study did not include peer-to-peer support from parents of former preterm infants and required parents to be in the hospital 3 h per day instead of 6 h per day. A FICare-based intervention bundle called Integrated Family Delivered Neonatal Care (IFDC) in the UK was shown to reduce overal length of stay and special care days and to shorten the time to full suck feeding compared with historical controls [50]. The IFDC bundle differed from FICare in that parents received additional support from IDFC coordinators and access to a free mobile app with educational information and a diary.…”

Scaling Up the Family Integrated Care Model in a Level IIIC Neonatal Intensive Care Unit: A Systematic Approach to the Methods and Effort Taken for Implementation

“…To reach proficiency, parents undergo specific training by professionals who act as teachers and guides. Short-term clinical benefits have been reported (23)(24)(25)(26)(27) in addition to decreased levels of stress and anxiety in their families (23,24). The empowerment of parents allows them to feel more secure in caring which in turn will reduce hospital stay and use of emergency services after discharge.…”

“…Therefore, not only benefits in health are expected but also socioeconomic benefits (28)(29)(30)(31). Up to date, reports on FICare model implementation are almost limited to stable preterm infants admitted to NICUs (23)(24)(25)(26)(27)(28)(29)(30)(31). However, turning parents into true experts in child care and development, as well as a source of love, protection, and support, is a path that should not be followed without careful planning.…”

Mapping family integrated care practices in the neonatal units across the UK

“…Among the respondents, 86% reported delivering some elements of FIC, the breadth of activities delivered are detailed in table 1. The perceived advantages of FIC included: reduced parental stress (72%), improved breast feeding (65%), improved neurodevelopmental outcomes (59%) and reduced hospital stay (54%); these were reflected in the multicentre cluster-randomised trial led by Mount Sinai Hospital in Toronto, Canada,2 and the outcomes of the Integrated Family Delivered Care project at Imperial neonatal units in the UK 3. Implementation of FIC focused on educational and environmental aspects.…”

“…Both this and the environmental support required for FIC require funding. But the mandate is clear, FIC improves infant and parental health outcomes2 3 and is the future direction of travel in neonatology.…”