259 - Improving Outpatient Follow-up for Infants with Neonatal Opiate Withdrawal

Publication Number: 259.5563

Polina Frolova Gregory, Seattle Children's Hospital, Seattle, WA, United States; Corrie E. McDaniel, University of Washington, Seattle, United States, Seattle, WA, United States; Karyn Yonekawa, Seattle Children's, Seattle, WA, United States

Background: Infants exposed to drugs in-utero and diagnosed with Neonatal Opioid Withdrawal Syndrome (NOWS) often encounter barriers to post-hospitalization follow-up, impacting timely primary care physician (PCP) visits and increasing emergency department utilization. Early follow-up may foster a therapeutic relationship that reduces unnecessary acute care use.

Objective: Our aim was to improve post-discharge follow-up for infants with NOWS.

Design/Methods: From December 2023 to June 2024, we implemented a multifaceted QI intervention in collaboration with hospitalists, neonatologists, nursing leadership, local PCP offices, and child protective services (CPS). Interventions included bedside scheduling of follow-up appointments by nurses and social workers, documenting follow-up in the after visit summary, providing a warm hand-off to the PCP, assisting caregivers with MyChart set up, integrating 1-week follow- into the plan of safe care with CPS, incorporating visual and written education specific to infants with NOWS at the time of discharge, and offering trauma-informed education for clinical staff. Primary outcome included completion of a post-hospitalization 1-week visit, while secondary outcomes measured attendance at the 1- and 6-month well-child checks. Data from hospital and clinic electronic health records was used to examine the baseline period (2/2022-9/2023) and post intervention period (12/2023-10/2024). We used Bayesian logistic regression models with flat priors to assess follow-up attendance probability.

Results: We identified 84 eligible infants; 52 infants in baseline, 32 in intervention (Table 1). Baseline 1-week follow-up was 90% (n=47) but only 73% (n=38) by the 6-month well-child check. Post intervention, 1-week follow-up remained high at 91% (n=29) and 6-month well-child check attendance improved to 92% (n=12). The probability of follow-up after the intervention increased by 1% (95% Confidence Interval [CI] -0.14, 0.13) at 1 week, 23% (95% CI 0.05, 0.40) at 1 month, and 20% (95% CI -0.02, 0.36) at 6 months (Table 2).

Conclusion(s): An interdisciplinary intervention successfully improved PCP follow-up rates for infants with NOWS, underscoring the value of cross-departmental collaboration in enhancing long-term continuity of care.

Table 1
Demographic and Clinical Characteristics of Infants NOWS

Table 2
Bayesian Logistic Regression Examining 1 Week, 1 Month, and 6 Month Follow-up