Variability in the systems of care supporting critical neonatal intensive care unit transitions

Abstract

Objective Assess practices supporting care transitions for infants and families in the neonatal intensive care unit (NICU) using a model of four key drivers: communication, teamwork, family integration, and standardization. Study design Single-day audit among NICUs in the Vermont Oxford Network Critical Transitions collaborative addressing policies and practices supporting the four key drivers during admission, discharge, shift-to-shift handoffs, within hospital transfers, and select changes in clinical status. Results Among 95 NICUs, the median hospital rate of audited policies in place addressing the four key drivers were 47% (inter-quartile range (IQR) 35–65%) for communication, 67% (IQR 33–83%) for teamwork, 50% (IQR 33–61%) for family integration, and 70% (IQR 56–85%) for standardization. Of the 2462 infants included, 1066 (43%) experienced ≥1 specified transition during the week prior to the audit. Conclusions We identified opportunities for improving NICU transitions in areas of communication, teamwork, family integration, and standardization.