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

9/29/14 Neonatology – Early 1900 � s Redesigning the Neonatal Intensive Care Unit More sideshow than medicine William Rhine, M.D. September 25, 2014 1 Modern Neonatal ICU 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 4 NICUs Around the World – NICUs Around the World What Do You See and Don’t See? � China – Beijing, Hangzhou 1) What is similar? a) Patients/families � Lucile Packard Children’s Hospital Stanford b) Medical staff c) Equipment � Children’s Hospital Orange County d) Physical space � Cook Children’s Hospital – Fort Worth, TX 2) What is different? 3) What drives differences? � Family Integrated Care – Estonia/Sweden 5 6 1

9/29/14 Bayi Children’s Hospital, Beijing 7 8 Bayi Children’s Hospital, Beijing Bayi Children’s Hospital, Beijing 9 10 Fudan Children’s Hospital, Shanghai Fudan Children’s Hospital, Shanghai 11 12 2

9/29/14 Fudan Children’s Hospital, Shanghai Fudan Children’s Hospital, Shanghai 13 14 Fudan Children’s Hospital, Shanghai Fudan Children’s Hospital, Shanghai 15 16 Fudan Children’s Hospital, Shanghai Fudan Children’s Hospital, Shanghai 17 18 3

9/29/14 Fudan Children’s Hospital, Shanghai Fudan Children’s Hospital, Shanghai US Version 19 20 Children’s Hospital of Zhejiang University, Fudan Children’s Hospital, Shanghai Hangzhou 21 22 Children’s Hospital of Zhejiang University, Children’s Hospital of Zhejiang University, Hangzhou Hangzhou 23 24 4

9/29/14 Children’s Hospital of Zhejiang University, Children’s Hospital of Zhejiang University, Hangzhou Hangzhou 25 26 Children’s Hospital of Zhejiang University, Children’s Hospital of Zhejiang University, Hangzhou Hangzhou 27 28 LPCH NICU – 1980’s Open bay style Children’s Hospital of Zhejiang University, Hangzhou 29 30 5

9/29/14 LPCH NICU – Supply Management LPCH NICU – Bedside setup 31 32 LPCH NICU – Medical Team Rounds 33 34 Children’s Hospital of Orange County Children’s Hospital of Orange County VISITOR SIGNAGE ENTRANCE SIGNAGE 35 36 6

9/29/14 Children’s Hospital of Orange County Children’s Hospital of Orange County 37 38 Children’s Hospital of Orange County Children’s Hospital of Orange County Small Baby Small Baby Private Room Private Room 39 40 Children’s Hospital of Orange County Children’s Hospital of Orange County Small Baby Small Baby Bay Rooms Bay Rooms 41 42 7

9/29/14 Children’s Hospital of Orange County Children’s Hospital of Orange County PATIENT INFO WHITEBOARD INSPIRING MESSAGING 43 44 Children’s Hospital of Orange County Children’s Hospital of Orange County INTERMEDIATE (STEPDOWN) NICU STAFF QUALITY IMPROVEMENT POSTER 45 46 Children’s Hospital of Orange County Children’s Hospital of Orange County NOISE REMINDER DEVICE STAFF QUALITY IMPROVEMENT POSTER 47 48 8

9/29/14 Children’s Hospital of Orange County Children’s Hospital of Orange County PARENT CHAIR FOR KANGAROO CARE FAMILY STAY ROOM 49 50 Cook Children’s Hospital – Ft. Worth Children’s Hospital of Orange County FAMILY STAY ROOM 51 52 Cook Children’s Hospital – Ft. Worth Cook Children’s Hospital – Ft. Worth PATIENT ROOM PARENT LOUNGE 53 54 9

9/29/14 Cook Children’s Hospital – Ft. Worth Cook Children’s Hospital – Ft. Worth PATIENT ROOM PATIENT ROOM 55 56 Cook Children’s Hospital – Ft. Worth Cook Children’s Hospital – Ft. Worth PATIENT ROOM PARENT STORAGE SPACE AND BREASTMILK FRIDGE 57 58 Cook Children’s Hospital – Ft. Worth Cook Children’s Hospital – Ft. Worth BREASTMILK WARMING DEVICES BEDSIDE MONITOR AND REMINDER NOTICE 59 60 10

9/29/14 Cook Children’s Hospital – Ft. Worth Cook Children’s Hospital – Ft. Worth INSIDE ROOM TRASH ACCESS TWIN ROOM 61 62 Cook Children’s Hospital – Ft. Worth Cook Children’s Hospital – Ft. Worth NURSING STATION PARENT LOUNGE 63 64 Cook Children’s Hospital – Ft. Worth Family Integrated Care Examples from Estonia, Canada and Sweden PARENT LOUNGE 65 11

9/29/14 Caring for Families Estonia NICU Care Model • Mother’s health and wellbeing � Parents are primary caregivers, not nurses is considered essential to the � Parents responsible for all care except IV, medications baby’s wellbeing: � Parents participate in rounds, reports, charting • Atmosphere of team support; � Encourage developmental & kangaroo care • Mother and baby are a unit; � Nurses are teachers and consultants • Nurse partners mother in the � Results = 30% reduction in nosocomial (hospital- baby’s care 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 Family Integrated Care – Uppsala, Sweden 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 12

9/29/14 Family Integrated Care – Uppsala, Sweden The Future NICU at LPCH Who and what influence NICU design? 74 13