Cedars-Sinai Shortens Premature Infants' Intensive Care Stays by 21 Percent in Past Three Years
Medical Advances Along with Coordinated Medical Care Dramatically Shortens Hospital Stays and Enables Babies to go Home to Families Sooner
Los Angeles - Sept. 3, 2014 - The amount of time premature babies spend in Cedars-Sinai's Neonatal Intensive Care Unit, part of the Maxine Dunitz Children's Health Center, has declined dramatically during the past three years, with the average length of stay dropping from 21 days to 17 days.
In recent years there have been some notable medical advances, such as personalized nutrition therapy that helps the smallest infants gain weight, nonsurgical procedures to heal heart defects and new medical protocols for mothers likely to deliver a premature infant. All have contributed to more rapidly improving the health of premature infants and shortening the infants' hospital stays. But one of the main reasons for the shorter hospitalizations is a renewed emphasis on coordinating each baby's various and complex health needs.
"Our goal always is to get our patients healthy and back home with their families as soon as possible," said Charles F. Simmons Jr., MD, chairman of the Department of Pediatrics and the Ruth and Harry Roman Chair of Neonatology in Honor of Larry Baum. "But often these babies have multiple health issues, and coordinating the various aspects of their care can be challenging."
To improve coordination, NICU teams, under the guidance of Asha Puri, MD, associate clinical director of the Neonatal Intensive Care Unit, developed checklists known as "discharge bundles" that remind doctors, nurses, social workers and parents to take care of essential items well before babies are discharged. The discharge bundle could include vaccination requirements, circumcision requests, reminders to order special medical equipment for home use, parental education and prompts to schedule follow-up appointments with specialists.
"Often, it seemed that many items on the list were delaying babies' departures from the NICU," said Puri. "Now, a discharge coordinator focuses on getting the infant ready to go home from the time the baby arrives in the NICU. Our goal is always reuniting a healthy baby with his or her family in as timely a fashion as possible. Keeping this focus front and center is changing the way we work and leading to earlier releases."
Ellen Mack, RNC, MN, neonatal clinical nurse specialist, explains while all hospital discharges can be complex, this is especially true in the NICU.
"Unlike other hospital patients, these are the only patients who have never been home before, and their parents have never taken care of them at home before," she said. "Parents are eager to get their children home, but often nervous."
To that end, Cedars-Sinai NICU specialists start working on each baby's discharge bundle as soon as the baby is admitted to the NICU, working with the parents on what special resources they might need in the hospital or at home, whether it's medical equipment or developmental services. The hospital has also instituted weekly bedside rounds with every healthcare provider involved in the infant's care, from social workers and therapists to nurses and doctors.
Additionally, Simmons noted that changes to standards of care for pregnant women also have had an impact. For example, women who have been identified as likely to deliver early may be given medication to help infants' lungs and brains mature. New standards also have been introduced to help prevent strep infections moving from mothers to babies.
"The combination of the discharge bundle, medical advances and new prenatal treatments has made a big difference," Simmons said. "The goal is always to shorten the amount of time that babies are separated from their families."