69 - Infant Safe Sleep Anticipatory Guidance: Catching Up to AAP Recommendations

Publication Number: 4067.69

Alexandra Epee-Bounya, Boston Children's Hospital, Boston, MA, United States; Katherine Barahona Paz, Boston Children's Hospital, cambridge, MA, United States; Jahmakah-Lynn Seals, Boston Children's Hospital, Boston, MA, United States; Anna Sophia Morales, Boston Children's Hospital, Boston, MA, United States; Gabriela Tew, Boston Children's Hospital, Boston, MA, United States; Shannon Regan, Boston Children's Hospital, Boston, MA, United States; Corinna J. Rea, Boston Children's Hospital, Medfield, MA, United States

Background: The pathology of sleep-related death in infancy is multifactorial and includes intrinsic vulnerability and exogenous trigger during a critical period of development. Despite the American Academy of Pediatrics' (AAP) updated policy statement on infant safe sleep released in 2022, most pediatricians in our practice only review only the "Back-to-Sleep" recommendations, omitting a comprehensive review of risk factor mitigation. This initiative establishes a multidisciplinary approach to improve delivery of safe sleep guidance.

Objective: By May 2026, increase screening, counseling, and documentation of comprehensive safe sleep anticipatory guidance beyond the "Back-to-Sleep" recommendation to 60% for all families presenting for well-child visits (WCVs) between birth to 4 months of age, regardless of their characteristics, including race/ethnicity, language, and insurance type.
Process Measures:
1. % of patients under 4 mo with documented comprehensive AAP guidance during WCV
2. % of families with unsafe sleep practices referred to Tier 2 HealthySteps counseling
Outcome Measure:
1. % of families with unsafe sleep practices with reported safe sleep practices at next WCV
Balancing Measure:
1. % of parents of patients under 4 mo who completed Edinburgh Postnatal Depression Scale (EPDS) screening during WCVs

Design/Methods: A QI initiative, centering around medical staff and trainee education, was implemented by a multi-disciplinary team (including medical providers, HealthySteps development specialist and Newborn Coordinator) using PDSAs and established QI methodology (Fig 1). Process and outcome measures were determined through monthly chart review of all completed WCVs for patients up to 4 mo and tracked with control charts. Cross sectional funnel plots (through Sep 25) for race/ethnicity, language, and insurance type (p=.10) were created to assess subgroup differences (Fig 2). Balancing measure data was collected through established electronic health record reports.

Results: AAP recommended safe sleep guidance increased from a baseline of 26% pre-intervention to an average of 42% post-intervention (Fig 3). The health equity analysis did not reveal any disparities in screening, counseling, and documentation of AAP safe sleep guidance based on race/ethnicity, language, and insurance type.

Conclusion(s): AAP safe sleep recommendations successfully increased in an equitable manner for families presenting at WCV of patients up to 4 months old. Comprehensive safe sleep anticipatory guidance delivery, in line with AAP guidelines, can be successfully implemented in collaboration with HealthySteps program.

Figure 1
Driver Diagram

Figure 2
Cross Sectional funnel plot of race/ethnicity of patients up to 4 months old who received AAP guidance during WCV

Figure 3
Percentage of patients under 4 months old with documented AAP guidance during WCV