106 - Implementation of the Safe Sleep Initiative to Improve Education, Documentation and Equity in the Neonatal Intensive Care Unit (NICU)

Publication Number: 3101.106

Yixin Xu, Loyola University Chicago Stritch School of Medicine, Chicago, IL, United States; Lindsey Young, Loyola University Chicago Stritch School of Medicine, Addison, IL, United States; Sachin Amin, Loyola University Chicago Stritch School of Medicine, Maywood, IL, United States

Background: Unsafe sleep practices remain a leading cause of preventable infant mortality in the post-neonatal period. The Illinois Perinatal Quality Collaborative (ILPQC) "Equity and Safe Sleep for Infants (ESSI)" initiative aims to ensure that every family receives culturally responsive education and that safe-sleep counseling and discharge documentation occur reliably. Safe sleep education remains inconsistent in the NICU. We implemented this quality initiative to improve parental education regarding safe sleep practices after discharge.

Objective: To improve (1) staff education regarding appropriate infant safe sleep practices, (2) documentation of parental understanding about safe-sleep counseling, (3) language interpreter utilization, (4) parental social determinants of health (SDOH) screening and linkage to ESSI bundle, and (5) documentation of the ESSI bundle in discharge summaries for all infants admitted to the NICU.

Design/Methods: Setting: Level III NICU at Loyola University Medical Center participating in the statewide ILPQC ESSI collaborative.
Intervention: Phased roll-out of standardized staff education regarding safe sleep best practices, bedside safe-sleep documentation templates, language interpreter and SDOH workflow prompts in Electronic Medical Record (EMR), and discharge-bundle verification.
Measures: Percent completion of ESSI bundle and other quality metrics by chart audit (monthly/quarterly). Target ≥ 80% for all metrics.
Analysis: Comparison of baseline (Q1 2024) versus most recent (Q3 2025) performance across domains, stratified by infant race and ethnicity to identify equity gaps.
This project was reviewed as a quality-improvement initiative and determined to be exempt from IRB review under institutional policy.

Results: Staff education completion improved from ≈10% to 100%.
Parent understanding of safe sleep increased from ≈58% to 95%; counseling documentation from ≈57% to 100%.
Language interpreter utilization documentation rose from ≈67% to ≈90-100%.
ESSI discharge-bundle documentation improved from 0% to ≈100%.
SDOH screening increased from ≈0-5% to ≈75%.
Racial/ethnic disparities narrowed, with all groups achieving ≥80% compliance by Q3 2025.

Conclusion(s): A structured, multidisciplinary approach within the ILPQC ESSI framework led to substantial and equitable improvements in safe-sleep education and documentation in the NICU.

Trends in Safe Sleep Documentation and Education Metrics (Q1 2024 - Q3 2025)
Quarterly trends showing improvement across six ESSI domains-staff education, parental understanding, counseling documentation, interpreter use, SDOH screening, and discharge-bundle inclusion-after standardized education and workflow implementation.

Components of the ESSI Safe Sleep Bundle
Summary of the three core ESSI bundle domains: Awareness (parent understanding of safe sleep), Readiness (SDOH screening and home transition preparation), and Transfer of Care (documentation of the ESSI Newborn Care Plan in the discharge summary).

Safe-Sleep Documentation Stratified by Infant Race and Ethnicity (Q1 2024 - Q3 2025)
Quarterly compliance with safe-sleep documentation stratified by infant race and ethnicity, demonstrating equitable improvement and convergence of all groups above the 80 percent target by Q3 2025.