Reducing NICU Discharge Care–Related Failures by Improving Discharge Safety

Abstract

BACKGROUND: Infants discharged from a neonatal intensive care unit (NICU) to unprepared caregivers are at risk for adverse events and hospital readmission. We developed strategies to improve caregivers’ ability to provide infant care after NICU discharge (DC). METHODS: Our interdisciplinary team developed a 7-year, single-center quality initiative to enhance caregivers’ abilities to care for infants after NICU DC. We tracked DC care–related failures (DCRFs), hospital readmissions, and caregiver training efficacy before and after implementing care training improvements. Key interventions included implementing standardized DC education with targeted feedback, establishing a DC navigator role, and performing post-DC phone calls to mitigate and quantify errors. Outcomes measured were DCRF rates, all-cause and preventable readmissions within 30 days of DC, caregiver/staff DC readiness, and satisfaction scores. RESULTS: Between 2013 and 2019, 3305 NICU DCs occurred and 44% (1,453) of caregivers were successfully contacted after DC. DCRFs were common, decreasing from 23% (79/342) at baseline to 11% (46/424) and 17% (114/687) in contacted caregivers during intervention and maintenance phases, respectively. Improvements were seen in feeding, oxygen, and primary care physician (PCP) follow-up–related DCRFs. Readmissions were infrequent with no differences between phases. Despite high DCRF incidence, caregivers consistently reported high DC readiness (≥90%). Nurse satisfaction with the DC process increased markedly from 2% (1/43) at baseline to 67% (40/60) in 2020. CONCLUSION: Following DC from the NICU, errors in medication and feeding administration, oxygen delivery, and PCP follow-up were not uncommon. However, study interventions enhanced caregivers’ ability to provide post-DC care, leading to a reduction in errors and potential infant harm.