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Improving Outcomes through a Neonatal Abstinence Syndrome Collaborative in MarylandFunding This collaborative was supported by funds awarded by the Maryland Department of Health Maternal and Child Health Bureau Title V Program.
Objectives A statewide Maryland Perinatal Neonatal Quality Collaborative, facilitated by the Maryland Patient Safety Center (MPSC), identified the three specific, measurable, attainable, relevant, and time-limited (SMART) aims to improve outcomes of neonatal abstinence syndrome (NAS) care as follows: (1) to reduce hospital length of stay (LOS), (2) to reduce interhospital transfers, and (3) to reduce 30-day readmission rates of infants with NAS.
Study Design The Maryland collaborative developed a bundle of best practices for care of infants with NAS. MPSC partnered with Vermont Oxford Network (VON) to utilize the VON NAS toolkit and provided its standardized NAS educational curriculum to address the three objectives for participating birthing hospitals. Efforts began in quarter 4 (Q4) of 2016 and continued for 2 years. Thirty-one of Maryland's 32 delivery hospitals (97%) participated in the 2-year collaborative. Additionally, one specialty pediatric hospital with an NAS unit participated in the group learnings. Participating facilities implemented components of the MPSC NAS bundle and provided their staff caring for infants with NAS and their mothers access to the VON standardized educational curriculum. MPSC partnered with VON to conduct two audits of implementation of policies and procedures in Q1 of 2016 and Q3 of 2018. The Maryland Department of Health supplied quarterly aggregate hospital information on LOS, interhospital transfers, and 30-day readmissions of infants with a discharge diagnosis of the International Classification of Disease, 10th Revision (ICD-10), P96.1.
Results Among term infants with NAS with total hospital stay greater than 5 days, we observed a nonsignificant reduction in both mean and median LOS of 1.5 days. In this same group, the rate of interhospital transfers fell significantly from 20.1% in 2016 to 13.8 and 11.0% in 2017 and 2018, respectively.
Conclusion The best practice bundle created by the Maryland collaborative was associated with a reduction in the percentage of infants with NAS who required interhospital transfer, thereby reducing family disruption.
A state NAS collaborative engaged 97% of delivery hospitals in education and standardization of care.
The collaborative witnessed a 1.5-day decrease in length of stay, similar to that observed in other state collaboratives.
The unique outcome of our collaborative was a 50% decrease in the rate of interhospital transfer.
Keywordsquality improvement - multicenter study - clinical outcomes - interhospital transfer - neonatal abstinence syndrome
B.D. conceptualized the MPSC NAS initiative, ran the statewide collaborative, reviewed serial outcomes data, drafted the initial manuscript, and reviewed and revised the manuscript.
K.S. performed data analysis and reviewed and revised the manuscript.
J.R. conceptualized the MPSC NAS initiative, assisted with the statewide collaborative, and reviewed and revised the manuscript.
L.W. assisted with the statewide collaborative, supplied outcomes data, and reviewed, and revised the manuscript.
E.M.E. performed data analysis and reviewed and revised the manuscript.
M.B.-F. facilitated the collaboration between MPSC and VON and reviewed and revised the manuscript.
J.D.H. reviewed and revised the manuscript.
M.L.H. served as a consultant to the statewide collaborative, reviewed serial outcomes data, drafted the initial manuscript, and reviewed and revised all versions of the manuscript.
All authors approve the final version of the manuscript as submitted.
M.L.H. was a paid consultant to the Maryland Patient Safety Collaborative. J.D.H. is Chief Executive Officer, President, Chief Scientific Officer, and an unpaid member of the Board of Directors of Vermont Oxford Network. E.M.E. receives salary support from Vermont Oxford Network. M.B.-F. was Executive Vice President and Director of Quality Improvement and Education at Vermont Oxford Network.
Received: 12 October 2021
Accepted: 18 March 2022
Accepted Manuscript online:
05 April 2022
Article published online:
06 June 2022
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