514 - Health Equity and Kangaroo Care: A Quality Improvement Initiative

Publication Number: 514.5473

Tatiana F. Lestido, Eastern Virginia Medical School/Children's Hospital of The King's Daughters, Norfolk, VA, United States; Kaitlin M. Ryan-Smith, Children's Hospital of The King's Daughters, Norfolk, VA, United States

Background: Kangaroo Care (KC), or skin-to-skin contact, is a proven NICU practice that reduces preterm complications, strengthens the child-parent bond, and supports neurological and emotional development. However, in our NICU, White infants receive nearly twice as many KC sessions and average 14 minutes longer per session than Black infants, revealing a significant health disparity.

Objective: Initial objective was to increase the number of KC sessions of Black babies by at least 20% (from 5 sessions to 6) by September 2024 as well increase the average length of KC sessions of Black infants by 12.5% (from 80 to 85 minutes) by September 2024. Globally we aimed to improve neurodevelopmental outcomes of neonates in the NICU by way of KC and decrease gaps in health equity.

Design/Methods: IHI Model for Improvement was used to create an aim statement, project charter, team outline, and stakeholder analysis. To assess KC practices, we defined variables, collected EMR baseline data, created a process map, designed a key driver diagram, and planned PDSA cycles.

Preliminary data indicated that White infants, on average, received about more than twice the number of Kangaroo Care sessions within the first 30 days of life compared to their Black counterparts, 5.2 vs 8.5 sessions, respectively. There was also a notable difference in the duration of these sessions, with White families averaging 94.6 minutes per session, while Black families average 80.2 minutes.

Results: After the first PDSA cycle, which introduced an informational package on Kangaroo Care, the average number of sessions for Black infants increased from 5 to 8, with session duration rising from 80 to 132 minutes. In the second cycle, where a logbook system was introduced, Black infants had an average of 3.3 sessions lasting 76 minutes, while White infants averaged 5.8 sessions of 75 minutes. Fewer infants were included in each cycle compared to baseline, which may have affected data outcomes.

Conclusion(s): The informational package on Kangaroo Care successfully exceeded targets for session frequency and duration among Black infants. However, the later introduction of a logbook system corresponded with reduced session numbers and duration, similar to averages for White infants. A key takeaway from this quality improvement project is that while educational interventions can effectively boost engagement, tracking systems like logbooks may unintentionally reduce participation. Future PDSA cycles could refine the logbook to attempt to maximize engagement or focus on more educational interventions such as videos or in-person classes.

Baseline Data
Number of Sessions (Left) & Average Time per Session (Right)

Post PDSA 1 Data
Number of Sessions (Top) & Average Time per Session(Bottom)

Post PDSA 2 Data
Number of Sessions (Left) & Average Time per Session (Right)