Increasing Parent Satisfaction With Discharge Planning

Abstract

Background: Neonatal intensive care unit (NICU) families are often overwhelmed by the discharge process. Their anxiety can inhibit learning and contribute to poor infant outcomes and increased healthcare utilization after discharge. Quality of the discharge teaching is the strongest predictor of discharge readiness, so NICUs must develop excellent discharge preparation programs. Purpose: This improvement project enhances NICU discharge preparedness by providing consistent, early discharge teaching using technology as a supplemental resource and raises parental satisfaction with the process. Methods: Neonatal intensive care unit staff and former NICU parents developed a task force to create technology-based discharge education content. The content was originally uploaded to an e-book and later transferred to the electronic health record inpatient portal. Families were able to view discharge teaching content at their own convenience and pace and review topics as needed with the NICU staff. Postdischarge follow-up phone calls provided insight into parental reaction to the new education format. Results: Parent satisfaction top-box scores, reflecting the highest rating in the “Prepared for Discharge” category of the patient satisfaction survey, improved from a baseline of 47% in 2017 to 70% in 2019. Overwhelmingly, 92% of families highly rated the tablet-based discharge teaching during postdischarge phone calls. Implications for Practice: A comprehensive, consistent, and early discharge program using technology can lead to more effective and efficient NICU discharge education and improved parent satisfaction. Implications for Research: Further studies are needed to generalize hospital-based inpatient portal teaching as an additional resource for parental education in the NICU.

No Place Like Home

“…Solutions proposed in the literature to address parental education and preparedness include (1) offering structured discharge teaching that begins shortly after admission, (2) using checklists and skills demonstrations for teaching, (3) carrying out systematic discharge readiness assessments to align educational needs with knowledge gaps, (4) encouraging parent self-assessments, and (5) teaching content that includes basic and specialty newborn care and home environment preparation. [2][3][4][5][6] Smith et al 3 recommends holding discharge planning meetings led by nurses to formalize the discharge preparation process. They explained that discharge planning meetings are necessary for parents to focus on discharge preparation, resulting in feeling more prepared.…”

“…Several published scientific reports have documented education and preparedness issues and solutions related to parents caring for their medically complex infants after NICU discharge; thus, this problem is far from unique. Solutions proposed in the literature to address parental education and preparedness include (1) offering structured discharge teaching that begins shortly after admission, (2) using checklists and skills demonstrations for teaching, (3) carrying out systematic discharge readiness assessments to align educational needs with knowledge gaps, (4) encouraging parent self-assessments, and (5) teaching content that includes basic and specialty newborn care and home environment preparation 2–6. Smith et al3 recommends holding discharge planning meetings led by nurses to formalize the discharge preparation process.…”

“…When the 498 participants were compared with matched controls, McKelvey's team showed the FBBH program led to more medical appointments and immunization compliance, and less infant deaths in the first year of life 6. Balasundaram et al4 are another program heralding successful outcomes. This team improved their parent satisfaction survey scores as it related to preparedness for hospital discharges by 23%.…”

Inclusion of Spanish-Speaking Families in NICU Symptom Research Using a Community Advisory Board

“…For example, CABs can offer continuous review of study measures throughout the entire translation process and improve cultural accuracy and sensitivity, maintain intended meaning and literacy levels, and advise the inclusion of additional items or changes in the research protocol. 29,30 Community-informed NICU research has also focused on program/study development and implementation, [31][32][33] but several studies have incorporated versions of CABs (eg, review committees) in the translation of NICU measures, composed mainly of medical and/or research experts. [34][35][36][37] Although most studies pilot test translated measures with the target population, few use advisory boards composed of imbedded community members that are not involved in research or medicine.…”

“…The use of CABs and advisory panels in the transcreation of study measures is also becoming more prominent, and research utilizing this method reflects its value. For example, CABs can offer continuous review of study measures throughout the entire translation process and improve cultural accuracy and sensitivity, maintain intended meaning and literacy levels, and advise the inclusion of additional items or changes in the research protocol 29,30…”