72 Going home safely, a family centred approach: facilitating the discharge process of preterm infant from neonatal intensive care unit

Background Qatar is a sovereign state in the Middle East. Our Neonatal Intensive care unit in Woman’s Wellness and Research Center(WWRC) is one of the largest Tertiary units in the Middle East with 20,000 deliveries per year and 4000 NICU admissions annually. Discharge process of preterm infants is a very complex issue that starts from the time of admission to discharge and follow-up post discharge. Preterm babies experience a much higher rate of hospital readmissions and death during the first year after birth compared with healthy term infants. Discharge plan should be individualized to address both parent and infant needs. Careful preparation for discharge and good follow-up arrangement after discharge may reduce these risks. Comprehensive discharge planning includes assessment of the neonate’s readiness for discharge and preparedness of families to care of their infant at home. Objectives Applying the concept of Family centered care increasingly offers families opportunity to participate in caregiving and decision making throughout their hospital stay, gradually building their confidence and competence. We aimed to improve the family participation in discharge process and reduce the percentage of cases being discharged post 4 hours from decision of discharge from 49%(our base line preintervention) to less than 20% in 12–18 months and reduce the readmission(in Methods A task force was formed to develop a comprehensive discharge readiness checklist. Discharge checklist contained various components to tick and sign by a team member/parent starting from 2 weeks prior to discharge till the day of discharge. It was reviewed daily during the ward rounds. As per the checklist parents were educated about medications, basic life support training, warning signs and symptoms of illness etc. This checklist was continuously audited with PDSA cycles and interventions introduced to correct the problems resulting in delayed/incomplete discharges. Parents were given a discharge folder that included all teaching handouts, medication sheets, growth charts, supplies, follow-up appointments with confirmed dates, relevant phone contacts and a copy of the discharge summary. Results We achieved >95% compliance with the discharge process checklist and a reduction in delayed discharges from 49% to 2%. we also achieved zero readmission rates Conclusions Discharge process requires a multi-disciplinary approach. Development of a comprehensive discharge planning toolkit facilitated the discharge process. This tool kit also enabled us in early identification of chronic cases nearing discharge. We recommend that NICU should form a discharge facilitation task force and develop a discharge checklist/toolkit according to their available resources. This will not only facilitate timely discharges but also has a positive impact on staff and parental satisfaction, bed occupancy rates, cost savings, and better patient flow. We believe this process makes parents a stakeholder in the care of the baby. We will be happy for any unit to contact us for further information and guidance.