Standardization of the Neonatal Intensive Care Unit Discharge Process

Abstract

Background Discharges are complex and any delay in discharge has significant impacts on NICU infants. Caring for infants in the NICU costs billions of dollars annually, with each day costing thousands of dollars. Accordingly, discharging these infants once they meet discharge criteria is vital for institutions to control expenses, but is also a quality and safety measure for these infants to successfully transition to home. Problem At a community hospital in Maryland a lack of a standardized discharge process contributed to increased discharge times and lengthy delays for NICU infants. If NICU infants were not discharged once medically stable, then the length of stay increased causing additional costs to the unit and hospital. Planning for discharge and after care of the infants is a key part of an effective process. This hospital had a significant need for a standardized discharge process, starting at admission and continuing through discharge. Interventions There are national recommendations for hospitals to focus on care that is timely and efficient. The American Academy of Pediatrics (AAP), the National Association of Neonatal Nurses (NANN) and the Agency for Healthcare Research and Quality (AHRQ) provide resources, programs, and toolkits for hospitals that wish to improve care transitions, including discharging the NICU infant once medically stable. The DNP student used the approach of a quality improvement initiative (QI) that involved developing and implementing a better-quality multidisciplinary discharge checklist into the electronic health record (EHR). The EHR checklist improved communication between the NICU team members in order to assure safe and costeffective discharge of NICU patients. This change in workflow prompted staff members to address discharge planning during each shift and enhanced communication between NICU parents and staff. Results This intervention led to a post-implementation average length of stay decrease from 9.92 days to 8.97 days respectively. Also, the discharge time past three o’clock decreased from an average of 54.84% to 36.00%. The imbedded discharge checklist was utilized by 100% of NICU staff, which standardized and improved the discharge process and documentation for NICU infants less than 37 weeks gestation. NICU team members utilized the discharge checklist in their daily rounding and during shift change, which improved discharge readiness and communication. Conclusions This QI project, led by a DNP student in partnership with a community hospital in Maryland, decreased the average length of stay and discharge time post-implementation while improving communication of all team members. This was a promising tool to maximize discharge planning starting from admission to improve outcomes of NICU infants. The electronic discharge checklist has the potential to serve as an example of a standardized and effective communication tool, which optimized outcomes for NICU infants and health care teams.