120 - From the Intensive Care Unit to High Risk Infant Follow Up Clinic: An Ongoing Quality Improvement Initiative to Improve High Risk Follow-Up After Discharge

Publication Number: 4118.120

Mary A. Masek, Children's Hospital Los Angeles, Los Angeles, CA, United States; Sahar Panjwani, Children's Hospital Los Angeles, Los Angeles, CA, United States; Kelly Luciani, 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: Close periodic surveillance of development is a cornerstone of care for high-risk infants discharged from the Neonatal Intensive Care Unit (NICU) and Cardiothoracic Intensive Care Unit (CTICU. High-risk infant follow-up (HRIF) programs are crucial in aiding pediatricians with developmental screening and facilitating referrals to early intervention programs and providing a multidisciplinary approach to education for families.

Objective: Our single centered quality improvement project at a free-standing quaternary care children's hospital aimed to increase referrals to the HRIF program and improve institutional awareness of the criteria required for referral.

Design/Methods: Data was collected via chart review on all patients discharged or transferred from the NICU or CTICU. Patients were included if they met California Children's Services (CCS) HRIF criteria. Data measures included referral rates to HRIF, discharge documentation of HRIF information, attendance to the appointments. Interventions from October to November 2024 included an education initiative created for providers on the referral process and talking points for families of patients prior to discharge. Education sessions included formal presentations, infographics in workrooms with key points, and reminder emails. Interventions from September to December 2025, include- updated workroom flyers to display criteria more clearly, a discharge order set that automatically populates HRIF appointment information into the discharge summary for families, and a HRIF handout to give to the family upon discharge. Data collection from October to January 2025 will reflect the second PDSA cycle.

Results: Comparing baseline data from January to June 2022 with data from October 2024 to February 2025- referral rates decreased from 89% to 87%, respectively; documentation of education increased from 7% to 35%, respectively; attendance to the first appointment increased from 43% to 46%, respectively. Data review from March to September 2025 showed an increase in documented education (38%), but a decrease in referral rates (64%) and follow up (36%).

Conclusion(s): There was a continued uptrend in provider education to families based on discharge documentation following the first PDSA cycle; however, the follow up rates and referral rates decreased and with less infants being referred, statistically less would attend the first appointment. It is unclear what contributed to the significant decrease and variability in referral rates, ranging from 61-97%. Future PDSA cycles will continue with the aim to educate our multidisciplinary team on qualifying criteria.

The Rate of Referral, Follow Up Appointments, and Education from Baseline Data to PDSA 1
NFP - Rate of Referral, Follow Up and Education.pdfThe rates of referrals, attendance to the initial follow up appointment, and documented education by providers in the discharge summary from chart review from baseline data (January to June 2022) through the first PDSA cycle (October to November 2024) and months following to trend rates beyond the first PDSA cycle interventions. There was an increase in the education rate. There was a decrease in referral rates and attendance to the first appointment.

Newborn Follow Up Program Process Map
Process Map HRIFNFP.pdfA comprehensive process map illustrating the referral, coordination, and follow-up workflow for infants who meet Newborn Follow Up Program (NFP) criteria. The map details each step from inpatient identification and referral initiation through hospital discharge, CCS authorization, and scheduling of the family's initial appointment.

Key Driver Diagram
Key Driver Diagram illustrating the relationship between the global and SMART aims, primary drivers, and targeted interventions designed to enhance first appointment attendance for infants meeting CCS criteria for HRIF. The diagram emphasizes physician and caretaker education, process streamlining, and improved accessibility of referral documentation to support early identification and intervention for developmental delays.