9/29/14 Neonatology Early 1900 s Redesigning the Neonatal - - PDF document

9/29/14 1

Redesigning the Neonatal Intensive Care Unit

1

William Rhine, M.D. September 25, 2014

Neonatology – Early 1900 s

More sideshow than medicine

History of Neonatology – The Patrick Bouvier Kennedy Story

THEN: Born 8/7/1963 at 34 ½ weeks gestational age, 4 ½ lb. (2.11 kg.); died after 2 days NOW: > 98% of such babies survive with normal lives

Modern Neonatal ICU

4

NICUs Around the World – What Do You See and Don’t See?

1) What is similar?

a) Patients/families b) Medical staff c) Equipment d) Physical space

2) What is different? 3) What drives differences?

5

NICUs Around the World

China – Beijing, Hangzhou Lucile Packard Children’s Hospital Stanford Children’s Hospital Orange County Cook Children’s Hospital – Fort Worth, TX Family Integrated Care – Estonia/Sweden

6

9/29/14 2

7

Bayi Children’s Hospital, Beijing

8

Bayi Children’s Hospital, Beijing

9

Bayi Children’s Hospital, Beijing

10

Fudan Children’s Hospital, Shanghai

11

Fudan Children’s Hospital, Shanghai

12

9/29/14 3 Fudan Children’s Hospital, Shanghai

13

Fudan Children’s Hospital, Shanghai

14

Fudan Children’s Hospital, Shanghai

15

Fudan Children’s Hospital, Shanghai

16

Fudan Children’s Hospital, Shanghai

17

Fudan Children’s Hospital, Shanghai

18

9/29/14 4 Fudan Children’s Hospital, Shanghai

19

US Version

Fudan Children’s Hospital, Shanghai

20

Fudan Children’s Hospital, Shanghai

21

Children’s Hospital of Zhejiang University, Hangzhou

22

Children’s Hospital of Zhejiang University, Hangzhou

23

Children’s Hospital of Zhejiang University, Hangzhou

24

9/29/14 5

Children’s Hospital of Zhejiang University, Hangzhou

25

Children’s Hospital of Zhejiang University, Hangzhou

26

Children’s Hospital of Zhejiang University, Hangzhou

27

Children’s Hospital of Zhejiang University, Hangzhou

28

Children’s Hospital of Zhejiang University, Hangzhou

29

LPCH NICU – 1980’s Open bay style

30

9/29/14 6 LPCH NICU – Bedside setup

31

LPCH NICU – Supply Management

32

LPCH NICU – Medical Team Rounds

33 34

Children’s Hospital of Orange County

35

ENTRANCE SIGNAGE

Children’s Hospital of Orange County

36

VISITOR SIGNAGE

9/29/14 7

Children’s Hospital of Orange County

37

Children’s Hospital of Orange County

38

Children’s Hospital of Orange County

Small Baby Private Room

39

Children’s Hospital of Orange County

Small Baby Private Room

40

Children’s Hospital of Orange County

Small Baby Bay Rooms

41

Children’s Hospital of Orange County

Small Baby Bay Rooms

42

9/29/14 8

Children’s Hospital of Orange County

43

PATIENT INFO WHITEBOARD

Children’s Hospital of Orange County

44

INSPIRING MESSAGING

Children’s Hospital of Orange County

45

INTERMEDIATE (STEPDOWN) NICU

Children’s Hospital of Orange County

46

STAFF QUALITY IMPROVEMENT POSTER

Children’s Hospital of Orange County

47

STAFF QUALITY IMPROVEMENT POSTER

Children’s Hospital of Orange County

48

NOISE REMINDER DEVICE

9/29/14 9

Children’s Hospital of Orange County

49

PARENT CHAIR FOR KANGAROO CARE

Children’s Hospital of Orange County

50

FAMILY STAY ROOM

Children’s Hospital of Orange County

51

FAMILY STAY ROOM

Cook Children’s Hospital – Ft. Worth

52

Cook Children’s Hospital – Ft. Worth

53

Cook Children’s Hospital – Ft. Worth

54

PARENT LOUNGE PATIENT ROOM

9/29/14 10

Cook Children’s Hospital – Ft. Worth

55

PATIENT ROOM

Cook Children’s Hospital – Ft. Worth

56

PATIENT ROOM

Cook Children’s Hospital – Ft. Worth

57

PATIENT ROOM

Cook Children’s Hospital – Ft. Worth

58

PARENT STORAGE SPACE AND BREASTMILK FRIDGE

Cook Children’s Hospital – Ft. Worth

59

BREASTMILK WARMING DEVICES

Cook Children’s Hospital – Ft. Worth

60

BEDSIDE MONITOR AND REMINDER NOTICE

9/29/14 11

Cook Children’s Hospital – Ft. Worth

61

TWIN ROOM

Cook Children’s Hospital – Ft. Worth

62

TRASH ACCESS INSIDE ROOM

Cook Children’s Hospital – Ft. Worth

63

NURSING STATION

Cook Children’s Hospital – Ft. Worth

64

PARENT LOUNGE

Cook Children’s Hospital – Ft. Worth

65

PARENT LOUNGE

Family Integrated Care

Examples from Estonia, Canada and Sweden

9/29/14 12

• Mother’s health and wellbeing

is considered essential to the baby’s wellbeing:

• Atmosphere of team support;
• Mother and baby are a unit;
• Nurse partners mother in the

baby’s care

Caring for Families

Estonia NICU Care Model

Parents are primary caregivers, not nurses Parents responsible for all care except IV, medications Parents participate in rounds, reports, charting Encourage developmental & kangaroo care Nurses are teachers and consultants Results = 30% reduction in nosocomial (hospital-

acquired) infection 30% improvement in weight gain 20% reduction in LOS 50% reduction in nurse utilization improved parent/staff satisfaction

Family Integrated Care Pilot Results

Mount Sinai Hospital, Toronto

• 25% improvement in weight gain
• Decreased nosocomial infection
• from 11.5% to zero
• Reduced critical incident reports
• from 10% to zero
• Decreased parental stress

Family Integrated Care – Uppsala, Sweden Family Integrated Care – Uppsala, Sweden Family Integrated Care – Uppsala, Sweden

9/29/14 13

Family Integrated Care – Uppsala, Sweden

The Future NICU at LPCH

Who and what influence NICU design?

74