129 - Following Through with NICU Follow-Up: A Quality Improvement Project

Publication Number: 3123.129

Emily Cox, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Shana Ratner, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Martin McCaffrey, UNC Chapel Hill School of Medicine, Chapel Hill, NC, United States; William S. Stoudemire, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Amy Scofield, UNC Health, Chapel Hill, NC, United States; Susan Lynch, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Genevieve Taylor, University of North Carolina, Chapel Hill, NC, United States

Background: Infants discharged from a neonatal intensive care unit (NICU) are at high risk of medical complications and developmental delays. NICU clinics identify delays and facilitate early intervention. Non-attendance is associated with increased disability and decreased access to early intervention services. At our institution, the Special Infant Care Clinic (SICC) provides follow-up care for high-risk NICU graduates. Baseline data of infants born < 32 weeks' gestation or with a diagnosis of hypoxic ischemic encephalopathy (HIE) demonstrated that only 63% attended at least one SICC appointment. Inconsistent referral processes and limited awareness of SICC and its benefits among staff and families were identified as key drivers of low attendance.

Objective: Increase SICC attendance for infants born < 32 weeks' gestation or with HIE from a baseline of 63% to 75% by October 2025.

Design/Methods: Our quality improvement project received an IRB waiver of approval and utilized the Model for Improvement framework. A key driver diagram guided interventions, including staff education, visual management tools, family-facing handouts, and streamlined referral workflows. Additionally, we are conducting interviews with parents to gain a deeper understanding of the barriers to attendance. Process measures include the percentage of infants with referrals or scheduled appointments prior to discharge. The primary outcome measure is attendance within eight weeks of discharge from the NICU. Data is analyzed monthly using control charts.

Results: Prior to project implementation, there was limited staff awareness of SICC and inconsistent communication with families about the clinic prior to discharge. Educational sessions were conducted to address these gaps, and a post-education survey indicated that 80% of staff felt confident discussing the purpose and importance of SICC with families. Additionally, shadowing opportunities, handouts, visual management tools, and changes to the referral order were implemented. While attendance has not yet shown sustained improvement across multiple PDSA cycles, these cycles have strengthened staff understanding of SICC, established consistent visuals for families, and helped identify key barriers to guide our next steps.

Conclusion(s): This ongoing quality improvement project aims to increase attendance at our NICU follow-up clinic by enhancing education, refining referral processes, and identifying barriers to attendance. Findings from this project may help other institutions improve NICU follow-up attendance.

Patients Born <32 Weeks' GA or with HIE Discharged Home from UNC NCCC with an SICC Appointment Scheduled Prior to Discharge
Figure 1: P-chart showing the percentage of eligible infants ( <32 weeks' gestation or with hypoxic-ischemic encephalopathy [HIE]) discharged home from the UNC Newborn Critical Care Center (NCCC) who had a Special Infant Care Clinic (SICC) appointment scheduled prior to discharge

Patients Born <32 Weeks' GA or with HIE Discharged Home from UNC NCCC Who Attended SICC Within 8 Weeks of Discharge
Figure 2: P-chart showing the percentage of eligible infants ( <32 weeks' gestation or with hypoxic-ischemic encephalopathy [HIE]) discharged home from the UNC Newborn Critical Care Center (NCCC) who attended a Special Infant Care Clinic (SICC) appointment within 8 weeks of discharge.

Patients Born <32 Weeks' GA or with HIE Admitted to the UNC NCCC Who Attended at Least One SICC Appointment
Figure 3: P-chart showing the percentage of eligible infants ( <32 weeks' gestation or with hypoxic-ischemic encephalopathy [HIE]) admitted to the UNC Newborn Critical Care Center (NCCC) who attended at least one Special Infant Care Clinic (SICC) appointment.