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Better Practices for Follow Through in NICU

June 19, 2024

Follow through.


Same thing? Not really—and not in the health care of children.

As the mother to four children, one of whom had disabilities and was medically complex, there is a big difference. Follow-up sounds, and often plays out more like, a one-time interaction. A check-in. But follow through sounds as if there is more than one item and one person involved.

In 2020, the Vermont Oxford Network (VON), a worldwide community of practice focused on improving quality, safety, and value of newborn care, laid out a list of “potentially better practices” (PBPs) for follow through, beginning before birth and into childhood. The follow-through approach involves professionals, families, and communities to look at the social and medical needs of infants and families. PBPs try to help infants and families before, during, and after hospital stays. “Potentially Better Practices for Follow Through in Neonatal Intensive Care Units,” published in this month’s Pediatrics, looks at if, and how, hospitals were able to use PBPs for follow-through (10.1542/peds.2023-065530).

What are some of the PBPs?

In total, the Vermont Oxford Network laid out 19 potentially better practices for follow through. Here are a few:

  • Include a paralegal on the team
  • Provide mental health services for families during the stay
  • Provide housing, meals, and transportation for families (and/or vouchers)
  • Provide sibling care
  • Provide language support and culturally appropriate interpretation and translation services
  • Conduct home visits before discharge and at intervals after discharge
  • Launch a fruit and vegetable prescription program
  • Develop strategies to involve families in quality improvement projects—and find funding for such roles

How did the authors do their study?

Authors sent a survey to all eligible US hospitals that were members of VON in 2023 (758 total). They asked hospitals how many of the PBPs they used. The authors organized hospitals by whether they were a safety-net hospital, by hospital ownership, and by NICU type. Comparisons between hospitals and their use of PBPs were made within each group.

What did the study find?

The authors lay out percentages of PBPs used in a table in the paper, but here are a few results:

  • Almost all NICUs have social workers, but only 16% have a paralegal or attorney on the follow-through team
  • 1% offered housing and 17.4% have an on-site food pantry
  • 9% of NICUs provided telehealth after discharge, and 11.7% did home visits
  • 7% reported including families in quality improvement, but only 10% had paid family advisors

Overall, the average number of PBPs at each hospital was 10 of the 19 total, but there was great variation, as some hospitals did not try any PBPs in follow through. Of those who answered the survey, they noted lack of time and resources (especially funding) as problems. Many hospitals shared the solid work being done in their NICUs to activate family-centered care, and some worried that follow-through after discharge or with focus on social needs might take away from existing work.

What can you do with this article?

  1. Read it and share with your child’s doctor.
  2. If you volunteer or work with the NICU, other hospital unit, or a clinic, share this article. Even if you are not working with a NICU, the potentially better practices may be able to help with other quality improvement or research work around how to help children and families with both social and medical needs.
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