Opioid use during pregnancy has escalated dramatically in recent years, paralleling the epidemic observed in the general population. Consequently, the incidence of newborns with Neonatal Abstinence Syndrome (NAS), which results from intrauterine opioid exposure, has increased 5-fold in the past 15 years. Monitoring and treatment of newborns with NAS varies across hospitals and can result in pharmacologic therapy, prolonged hospitalizations, and substantial healthcare costs. To standardize care, Grossman et al (10.1542/peds.2016-3360) developed the Eat, Sleep, Console approach, which focuses on a simplified assessment of newborns with NAS and maximizing non-pharmacologic treatment. Eat, Sleep, Console has been associated with dramatic reductions in length of stay (LOS) and hospital costs without apparent adverse effects; however, limited data on broad, statewide adoption have been published.
In a recent article published in Hospital Pediatrics, (10.1542/hpeds.2020-0032) authors formed a multi-site statewide multidisciplinary collaborative, the Colorado Hospitals Substance Exposed Newborn Quality Improvement Collaborative (CHoSEN QIC), to improve the care of newborns with NAS. They used the Breakthrough Series model, a well-known framework from the Institute for Healthcare Improvement, to inform their work. They engaged a wide array of stakeholders, including academic, public health, and policy organizations. In addition, participating hospitals each developed a local multidisciplinary improvement team. These teams developed hospital-specific interventions that targeted four key drivers: 1) standardizing NAS assessment using the Eat, Sleep, Console approach, 2) increasing the use of human milk, 3) improving non-pharmacologic, comfort care prior to initiating opioid therapy, and 4) administering opioid therapy only on an as needed rather than scheduled basis. Over the two-year study period, authors reported a significant decrease in average LOS from 14.8 days to 5.9 days and reduction in receipt of pharmacologic therapy from 61% to 23% of all opioid-exposed newborns. Among those newborns who received pharmacologic therapy, average LOS also decreased from 21.9 days to 8.0 days.
As discussed in the commentary in Hospital Pediatrics, (10.1542/hpeds.2020-001149) next steps may include focusing on additional initiatives that promote sustainment and expansion to the remainder of hospitals throughout the state, with special attention given to specific characteristics unique to each site. As many states already have perinatal quality improvement collaboratives in place, this study can serve as a model for other multi-site statewide initiatives to standardize care for newborns with NAS.
