Aggregating patients for discharge readiness in the neonatal intensive care unit: impact on length of stay

Abstract

Background: In the past 30 years, neonatal intensive care unit (NICU) layout in the United States has steadily shifted from open bay wards to single family room models. There is currently no published standardized approach for care team assignment in a NICU. Medical centers have decreased emergency department (ED) door-to-discharge time using acuity aggregation methods. We hypothesized aggregating NICU patients by acuity level would be associated with shorter length of stay (LOS). Methods: We conducted a retrospective, cross-sectional, pre-post study of 1,118 infants admitted and discharged from a level III NICU in an urban setting in the United States between July 2016 and March 2018 (pre-aggregation) vs. April 2018 and December 2019 (post-aggregation). Generalized linear regression was used to evaluate care team assignment and NICU LOS. Results: For infants ≥37 weeks gestational age (GA), NICU LOS decreased significantly after aggregating patients by acuity level, after controlling for infant and maternal characteristics. Average marginal effect for NICU LOS in infants ≥37 weeks GA was −3.5 days [95% confidence interval (CI), −6.8 to −0.1] after aggregating patients by acuity level, translating into 599 fewer NICU days during the post-aggregation period. NICU LOS for infants with GA <37 weeks did not significantly differ between aggregation periods. Conclusions: The 3.5-day reduction in LOS for infants 37 weeks GA and greater is clinically important, as infants benefit from going home sooner to bond and grow with their guardians. The accumulation of reduced days across hundreds of patients has the potential to reduce costs for both families and the hospital.