Parental perception of neonatal retro-transfers from level 3 to level 2 neonatal intensive care units

The perception of safety regarding the transfer of infants from the neonatal intensive care unit to a level II neonatology department: a mixed-method cohort study using a Safety-II approach

OBJECTIVE

This study aimed to investigate the perceived safety during the transfer process of infants from a Neonatal Intensive Care Unit (NICU) to a regional level II department. It sought to identify stakeholder agreements and divergences on safety and to determine the facilitators and barriers to achieving a high level of perceived safety.

DESIGN

This study employed a mixed-method cohort design and action research approach grounded in Safety-II principles.

SETTING

The study focused on transfers from a single Dutch university hospital NICU to multiple regional level II neonatology departments.

METHODS

Surveys were administered to parents and care professionals, including NICU staff, level II department staff, and ambulance personnel. The surveys consisted of both quantitative and open-ended questions. Data were analysed quantitatively and qualitatively, incorporating Safety-I and Safety-II perspectives, to assess the perceived safety and identify facilitators and barriers.

RESULTS

A total of 46 transfers were evaluated by 239 stakeholders. The overall perception of safety was positive among all stakeholder groups. There were no significant differences in the overall level of perceived safety between parents and care professionals. However, stakeholder perceptions varied significantly across transfer phases. Qualitative analysis revealed facilitators and barriers related to timing, parental participation and information exchange.

CONCLUSION

This study indicated consistently positive safety perceptions among parents and care professionals. Effective communication, parental participation and optimal timing were identified as crucial for enhancing safety perceptions during transfers.

Parent Perceptions of Transitioning From a 6-Bed Pod to a Single Family Room in a Mixed-Room Design NICU

BACKGROUND

As some neonatal intensive care units (NICUs) shift toward mixed-room designs, with different room types available throughout family's stays, there is a need to better understand parent perceptions of this transition.

METHODS

This study used a qualitative descriptive design to describe parent perceptions of transitioning from a 6-bed pod to a single family room in a mixed-room design NICU. Purposive sampling was used to recruit 10 mothers and 7 fathers who were regularly present on the unit before and after the transition. Semistructured telephone interviews were conducted a minimum of 2 days after the transition occurred. Interviews were transcribed and then analyzed using reflexive thematic analysis.

FINDINGS

Four themes were identified: going into the unknown; approaching the finish line; becoming comfortable in the new reality and seeing the benefits; and gaining autonomy and confidence in parenting.

CONCLUSION

These results further our understanding of the transition process from a 6-bed pod to a single-family room for parents in the NICU. Staff should be sensitized to this experience to provide tailored information and support for parents throughout the transition.

A Quality Improvement Project to Decrease Suboptimal Patient Transfers between Two Neonatal Units

Poorly executed transitions of care in health care systems are associated with safety concerns and patient dissatisfaction. We noticed several problems in the transfer process between our neonatal intensive care unit (NICU) and special care nursery (SCN) and designed this quality improvement project to address them. The aim was to decrease suboptimal transfers from the NICU to the SCN by 50% over 9 months. We defined suboptimal transfers as the discharge of a patient within 3 days of transfer from the NICU to the SCN or the return of a patient to the NICU within 5 days of the transfer.

Methods

We formed a multidisciplinary team and collected baseline data from October 2019 to December 2020. Major interventions included implementing a transfer checklist and algorithm. We utilized 3 staff surveys to evaluate the progress of the project. We used statistical process control charts to track project measures over time.

Results

Patient demographics and SCN length of stay were similar for the baseline and postintervention periods. We decreased suboptimal transfers over 21 months (January 2021 to September 2022), achieved a significantly increased rate of parent notification before transfers (81% baseline versus 93% postintervention), and increased staff satisfaction with the transfer process (15% baseline versus 43% postintervention).

Conclusions

We successfully improved the transfer process from our NICU to the SCN via a quality improvement project. Increased staff satisfaction and the lack of perception of additional burden to the staff from the new process are expected to sustain our results.

Parental perception of neonatal transfers from level 3 to level 2 neonatal intensive care units in Calgary, Alberta: qualitative findings

Background

Retro-transfers from level 3 to 2 NICUs in Alberta’s regionalization of neonatal care system are essential to ensure the proper utilization of level 3 NICUs for complex neonatal cases. Parents often experience distress that relates to the transfer of their neonates to another hospital. Limited information is available regarding parental perceptions of distress during transfers for neonates requiring care between NICUs in the current Canadian context. The objective of this study was to investigate: 1) what caused parents distress and could be changed about the transfer process and 2) the supports that were available to help ease parental distress during the transfer process.

Methods

Parents of singleton infants retro-transferred from level 3 to 2 NICUs in Calgary, Alberta between January 1, 2016, and December 31, 2017, were invited to participate in the study. Questionnaires were self-administered by one parent per family. A thematic deductive approach was employed by the researchers to analyze the qualitative data.

Results

Our response rate was 39.1% (n = 140). We found three themes for causes of parental distress and supports available to ease parental distress during the transfer, including communication between staff members and parents, details about the transfer process, and the care received throughout and shortly after the transfer process.

Conclusion

Parents should receive at least 24 h of notice, regular transfer updates, employ anticipatory preparation strategies, and foster more open communication between parents and health care professionals to help ensure parental satisfaction.