WIP 07 - Improving High Risk Infant Follow-Up after Neonatal and Cardiac Intensive Care Unit Discharge: A Quality Improvement Initiative

Publication Number: WIP 07.7589

Sahar Panjwani, Children's Hospital Los Angeles, Los Angeles, CA, United States; Alejandra Mallorga Hernandez, Children's Hospital Los Angeles, Los Angeles, CA, United States; Kelly Luciani, Children's Hospital Los Angeles, Los Angeles, CA, United States; Lexi Masek, Children's Hospital Los Angeles, Los Angeles, CA, United States; Joyce Koh, Children's Hospital Los Angeles, Los Angeles, CA, United States; Christine B. Mirzaian, Children's Hospital Los Angeles, Los Angeles, CA, United States

Background: High-risk infant follow-up (HRIF) programs are crucial in aiding pediatricians with developmental screening and facilitating referrals to early intervention programs as well as providing a multidisciplinary approach to education for families. Studies show that infants who meet criteria for referral to HRIF programs often are not referred at the time of hospital discharge from the Neonatal or Cardiothoracic Intensive Care Unit (NICU/CTICU) and have poor attendance to their HRIF follow-up appointments.

Objective: A single-centered quality improvement project was undertaken at our free-standing quaternary care children’s hospital to increase referrals to the HRIF program and improve provider awareness of the criteria required for referral.

Design/Methods: This study received exemption from IRB review. A process map and fishbone diagram were used to analyze process. Baseline data was collected via chart review looking at infant discharges from the NICU, CTICU, and inpatient wards from January to June 2022 and a 2-year follow-up period to determine the primary outcome measure: attendance to follow-up appointments. Process measures included proportion of patients who met criteria who were referred and proportion of infants who had documented education from providers regarding HRIF. Inclusion criteria was based on HRIF medical eligibility criteria which resulted in 151 qualifying patients. Run charts were utilized for measures using monthly data intervals.
Baseline data showed that median 89% of patients who met criteria were referred and 43% attended their first appointment. Additionally, 7% of infants had documented education about HRIF. Based on this data, an educational initiative was created for providers on the referral process and talking points for families of patients prior to discharge. Educational sessions were conducted from October to November 2024 and included formal presentations, infographics in workrooms with key points, and reminder emails.
PDSA cycles are planned for October 2024 to February 2025 with further chart reviews to determine measures.