118 - SOLVE: A Multidisciplinary Quality Improvement Approach to Shorten NICU Stay for Infants ≥35 Weeks

Publication Number: 4116.118

Nicole K. Buzalka, Cleveland Clinic Children's, Cleveland, OH, United States; Jordan Meade, Cleveland Clinic Children's, Seven Hills, OH, United States; Mohamed A. Mohamed, Cleveland, Cleveland, OH, United States; Ajith Mathew, Cleveland Clinic Children's, Cleveland, OH, United States

Background: Length of stay (LOS) is a major driver of neonatal intensive care unit (NICU) costs. In developed settings, NICU care costs approximately $1,250–$2,500 per day (Sharma & Murki, 2021). Even among late preterm and term infants, extended stays contribute disproportionately to hospital spending, with total newborn costs averaging $2,400–$3,000 per case for term infants and rising rapidly with each additional day (Phibbs et al., 2019; Jabbour et al., 2024). Reducing unnecessary NICU days in infants ≥35 weeks’ gestation therefore offers substantial clinical and financial benefit.

Objective: To decrease NICU LOS among infants ≥35 weeks’ gestation through a multidisciplinary quality improvement (QI) project focused on discharge readiness, care coordination, and feeding/fluid standardization.

Design/Methods: Baseline national data from 23,248,629 full-term infants, 880,950 infants at 36 weeks, and 478,282 infants at 35 weeks (excluding major congenital anomalies) showed mean LOS of 2.4, 4.0, and 6.0 days, respectively. At Cleveland Clinic Children’s Fairview NICU, the average LOS for infants ≥35 weeks was 5.35 days. Using an A3 QI framework, key drivers of prolonged LOS were identified: variation in thermoregulation, feeding advancement, discharge criteria, and care team communication. Interventions included a standardized thermoregulation protocol, daily multidisciplinary huddles, defined fluid and feeding goals, and an early feeding advancement pathway.

Results: Average LOS decreased from 5.35 days (2020 baseline) to 3.71 days (February 2021)—a 30.6% reduction. Importantly, there was no increase in readmissions or adverse outcomes. Based on published daily NICU cost estimates, this improvement represents a potential savings of $1,600–$2,200 per day avoided per infant.

Conclusion(s): Standardizing thermoregulation and feeding advancement, combined with structured communication across NICU teams, effectively reduced LOS for late preterm and term infants without compromising safety. This QI initiative demonstrates how targeted, team-based interventions can improve both efficiency and value in neonatal care, with future plans to implement the same protocol at other Cleveland Clinic Children’s NICUs, including Hillcrest Hospital.