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The major limitation in capacity for care of low birthweight
infants is the lack of intensive care cots. Experience from several
neonatal networks suggests that a major limitation to appropriate
use of intensive care facilities is inability to move infants from
intensive care to high dependency or special care cots because of
delays in discharge of infants from these cots. Enabling
well-prepared parents to take their infant home sooner would result
in a relatively small potential cost saving at the LNU level, but
would have a disproportionate effect in improving availability of
intensive care cots and allowing the most effective use of scarce
resources.
The aim of the planned interventions is to improve parents' self
efficacy and confidence in looking after their baby both before and
after discharge, to improve parents' experience of having a baby in
a neonatal unit, and to reduce the length of stay of preterm
infants from local neonatal units (LNU). By improving parental
confidence and knowledge we hope to also reduce health and social
care utilisation after discharge.
In the past Health Visitors had a major role in providing
generic care and support to all infants, particularly those at high
risk such as those discharged from neonatal units. The changing
role of health visitors from a predominantly health based role to
one much more focused on the monitoring, prevention and
identification of child neglect and abuse means that many are less
experienced in the care of ex-preterm infants, and early care after
discharge is commonly based on hospital based community outreach
teams. The planned intervention is well adapted to this changing
pattern of post discharge care, aiming to improve parents'
confidence, knowledge and experience, and allowing continuity of
approaches during and after the stay in a neonatal unit.
Our recent survey of senior staff in neonatal units across the
UK showed that a more systematic and family-centred approach in the
neonatal unit would be welcomed. The 'parent pack' planned for use
in the current study has been developed in close collaboration with
parents and staff working in several neonatal units. It aims to
facilitate family-centred care in the NHS in compliance with NICE
guidance [2010], which states that parents are encouraged and
supported to be involved in planning and providing care for their
baby, that regular communication with clinical staff occurs
throughout the care pathway, and that health and social plans are
coordinated to facilitate a seamless transition from hospital to
home. If this approach can improve parents' confidence, shorten LOS
and reduce readmission rates, it will help reduce workloads and
facilitate the most appropriate use of scarce manpower resources in
neonatal and infant wards.
Many neonatal units run at or above recommended occupancy
levels, and thus improved discharge planning may increase parental
satisfaction and optimise efficient use of cots / resources,
facilitate optimal staff deployment with potential benefits to
quality of care. However cost savings can potentially be made with
the reduction of unplanned (e.g. A&E) attendances and reduction
of missed outpatient appointments together with a reduction in
readmission rates. This trial is an organisational initiative for
use in LNU to evaluate an approach to service delivery with the
aims of improving parents' self efficacy, and reducing LOS and
readmission rates. If effective these changes would have major
implications in NHS service delivery within 2-3 years.
Dissemination: We will present and discuss the findings of the
study with the South West Neonatal Forum which meets twice a year
and is attended by clinicians, managers and nurses from across the
Western and Peninsula networks. We will also present the findings
and discuss them with the newly formed National Neonatal Alliance
(with representatives from the British Association of Perinatal
Medicine (BAPM), BLISS, Royal Colleges of Obstetrics and
Gynaecology, Royal College of Nursing, Royal College of Midwives,
and the Neonatal Nurses Association). This alliance has been formed
to explore QIPP opportunities and to support national initiatives
and so could very rapidly disseminate the findings and support
incorporation into practice and delivery of neonatal services.
Research outputs will be published in peer-reviewed journals and
presented at national and international conferences. Members of the
research team (PJF, JI, PSB, HB) have extensive experience in
developing and implementing changes in clinical service provision
and running multi-professional training and education activities to
effect such changes successfully. A key component in the
implementation of the results of this study if shown to be
effective will be local, regional and national parents' networks
and we will actively involve BLISS and our Parent Advisory Group in
this part of the dissemination.
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