Background-Standardized practices for the management of neonatal abstinence syndrome (NAS) are as... more Background-Standardized practices for the management of neonatal abstinence syndrome (NAS) are associated with shorter lengths of stay, but optimal protocols are not established. Aim-Identify practice variations for newborns with in-utero chronic opioid exposure among hospitals in the Better Outcomes through Research for Newborns (BORN) network. Methods-Nursery site leaders completed a survey about hospitals' policies and practices regarding care for infants with chronic opioid exposure (≥3 weeks). Results-The 76/95 (80%) respondent hospitals were in 34 states, varied in size (<500->8000 births and <10->200 opioid-exposed infants/year), with most affiliated with academic centers (89%). Most (85%) had protocols for newborn drug exposure screening; 95% used risk-based approaches. Specimens included urine (81%), meconium (73%) and umbilical cords (10%). Of sites (88%) with NAS management protocols, 77% addressed medical management, 72% nursing care, 72% pharmacologic treatment and 58% supportive care. Morphine was the most common
most months post-intervention are above the previous mean although the results are again not sign... more most months post-intervention are above the previous mean although the results are again not significant. CONCLUSIONS AND NEXT STEPS: After two PDSA cycles, there was no significant impact of PCP identification on admission, determined to be two standard deviations above the baseline of 59%. There was an upward trend of identifying PCP by name only versus including the address and phone number after the first intervention, however it was not sustained in time. Contributing to less than projected results were non-categorial pediatric residents who not only missed orientations sessions. There was also inadequate buy-in from all residents (categorical pediatrics and non-categorical) across time. The project is continuing for the 2016-2017 academic year with increased emphasis on education including off-service residents.
of feedback that were identified in phase one of the study. This survey, which utilized a 5-point... more of feedback that were identified in phase one of the study. This survey, which utilized a 5-point Likert scale to determine the importance of each feedback item, was sent out electronically to all categorical residents at each academic center. Results were analyzed with the mean and standard deviation for each question calculated. RESULTS: Focus groups were held at 3 sites with 3-10 residents per focus group. Consistent major themes which arose from the focus groups at all sites as desired areas to receive feedback on CC practice included the following categories: patient panel characteristics, quality measures, measures of efficiency in patient care, population management and information on specific patients. For the second phase of the study, 277 residents received the survey with 92 responding (33% response rate). The mean value that residents placed on the importance of each content area is displayed (table ) with 1 being not important at all and 5 being very important. CONCLUSION: Residents are interested in receiving practice habit data from continuity clinic. Presentation of the feedback described may enhance the resident continuity clinic experience and improve overall performance and enhance patient care.
ImportancePharmacologic agents are often used to treat newborns with prenatal opioid exposure (PO... more ImportancePharmacologic agents are often used to treat newborns with prenatal opioid exposure (POE) despite known adverse effects on neurodevelopment. Alternative nonpharmacological interventions are needed.ObjectiveTo examine efficacy of a vibrating crib mattress for treating newborns with POE.Design, Setting, and ParticipantsIn this dual-site randomized clinical trial, 208 term newborns with POE, enrolled from March 9, 2017, to March 10, 2020, were studied at their bedside throughout hospitalization.InterventionsHalf the cohort received treatment as usual (TAU) and half received standard care plus low-level stochastic (random) vibrotactile stimulation (SVS) using a uniquely constructed crib mattress with a 3-hour on-off cycle. Study initiated in the newborn unit where newborns were randomized to TAU or SVS within 48 hours of birth. All infants whose symptoms met clinical criteria for pharmacologic treatment received morphine in the neonatal intensive care unit per standard care.Ma...
Importance Mindfulness curricula can improve physician burnout, but implementation during residen... more Importance Mindfulness curricula can improve physician burnout, but implementation during residency presents challenges. Objective To examine whether a novel mindfulness curriculum implemented in the first 6 months of internship reduces burnout. Design, Setting, and Participants This pragmatic, multicenter, stratified cluster randomized clinical trial of a mindfulness curriculum randomized 340 pediatric interns to the intervention or control arm within program pairs generated based on program size and region. Fifteen US pediatric training programs participated from June 14, 2017, to February 28, 2019. Interventions The intervention included 7 hour-long sessions of a monthly mindfulness curriculum (Mindfulness Intervention for New Interns) and a monthly mindfulness refresher implemented during internship. The active control arm included monthly 1-hour social lunches. Main Outcomes and Measures The primary outcome was emotional exhaustion (EE) as measured by the Maslach Burnout Inventory 9-question EE subscale (range, 7-63; higher scores correspond to greater perceived burnout). Secondary outcomes were depersonalization, personal accomplishment, and burnout. The study assessed mindfulness with the Five Facet Mindfulness Questionnaire and empathy with the Interpersonal Reactivity Index subscales of perspective taking and empathetic concern. Surveys were implemented at baseline, month 6, and month 15. Results Of the 365 interns invited to participate, 340 (93.2%; 255 [75.0%] female; 51 [15.0%] 30 years or older) completed surveys at baseline; 273 (74.8%) also participated at month 6 and 195 (53.4%) at month 15. Participants included 194 (57.1%) in the Mindfulness Intervention for New Interns and 146 (42.9%) in the control arm. Analyses were adjusted for baseline outcome measures. Both arms' EE scores were higher at 6 and 15 months than at baseline, but EE did not significantly differ by arm in multivariable analyses (6 months: 35.4 vs 32.4; adjusted difference, 3.03; 95% CI, -0.14 to 6.21; 15 months: 33.8 vs 32.9; adjusted difference, 1.42; 95% CI, -2.42 to 5.27). None of the 6 secondary outcomes significantly differed by arm at month 6 or month 15. Conclusions and Relevance A novel mindfulness curriculum did not significantly affect EE, burnout, empathy, or mindfulness immediately or 9 months after curriculum implementation. These findings diverge from prior nonrandomized studies of mindfulness interventions, emphasizing the importance of rigorous study design and suggesting that additional study is needed to develop evidence-based methods to reduce trainee burnout. Trial Registration ClinicalTrials.gov Identifier: NCT03148626.
Background Physician burnout affects many physicians and is associated with decreased patient saf... more Background Physician burnout affects many physicians and is associated with decreased patient safety and physician health. Mindfulness curricula can reduce burnout but are often impractical to implement during residency. Objectives: To determine how a novel 6-month mindfulness curriculum designed for pediatric trainees impacts physician burnout, mindfulness, and empathy. Methods 15 pediatric residency programs’ interns participated in a stratified, cluster randomized controlled trial of the “Mindfulness Intervention for New Interns” (MINdI) curriculum. Participants completed the Maslach Burnout Inventory, Five Facet Mindfulness Questionnaire, and 2 Interpersonal Reactivity Index empathy scales and measures of mindfulness-related knowledge, attitudes and behaviors. Burnout was defined as an emotional exhaustion (EE) score >= 27 or a depersonalization (DP) score >= 10. The primary outcome was EE score. Missing data was addressed by conducting 20 data imputations. To determine impact of study arm on outcomes, we conducted logistic and GEE regressions clustered on site while controlling for factors that differed by arm. Results 340/365 invited interns completed the baseline survey (93.1%), and 254 completed follow-up (69.6%). At baseline, the mean EE score of the MINdI and control arms did not significantly differ (coef. -0.25; 95% CI: -4.54, 4.04), but the odds of burnout was significantly higher in the MINdI arm than controls (OR 2.73; 95% CI: 1.005, 7.43). Compared to controls, there were significantly higher mindfulness-related knowledge, attitudes, and behavior and higher EE scores in the MINdI arm at follow-up (coef. 2.45; 95% CI: 0.90, 6.66). At follow-up, burnout, mindfulness, or empathy scores did not significantly differ by arm. Conclusion Interns randomized to experience MINdI had higher EE despite increased knowledge, attitudes, and behaviors about mindfulness. The MINdI curriculum did not affect burnout, mindfulness nor empathy. As the curricula improved some measures of learning but increased EE future rigorous study of curricula to reduce physician burnout is needed.
most months post-intervention are above the previous mean although the results are again not sign... more most months post-intervention are above the previous mean although the results are again not significant. CONCLUSIONS AND NEXT STEPS: After two PDSA cycles, there was no significant impact of PCP identification on admission, determined to be two standard deviations above the baseline of 59%. There was an upward trend of identifying PCP by name only versus including the address and phone number after the first intervention, however it was not sustained in time. Contributing to less than projected results were non-categorial pediatric residents who not only missed orientations sessions. There was also inadequate buy-in from all residents (categorical pediatrics and non-categorical) across time. The project is continuing for the 2016-2017 academic year with increased emphasis on education including off-service residents.
The incidence of Neonatal Abstinence Syndrome (NAS) continues to rise and there remains a critica... more The incidence of Neonatal Abstinence Syndrome (NAS) continues to rise and there remains a critical need to develop non-pharmacological interventions for managing opioid withdrawal in newborns. Objective physiologic markers of opioid withdrawal in the newborn remain elusive. Optimal treatment strategies for improving shortterm clinical outcomes and promoting healthy neurobehavioral development have yet to be defined. This dualsite randomized controlled trial (NCT02801331) is designed to evaluate the therapeutic efficacy of stochastic vibrotactile stimulation (SVS) for reducing withdrawal symptoms, pharmacological treatment, and length of hospitalization, and for improving developmental outcomes in opioid-exposed neonates. Hospitalized newborns (n = 230) receiving standard clinical care for prenatal opioid exposure will be randomly assigned within 48hours of birth to a crib with either: 1) Intervention (SVS) mattress: specially-constructed SVS crib mattress that delivers gentle vibrations (30-60 Hz, ~12 μm RMS surface displacement) at 3-hr intervals; or 2) Control mattress (treatment as usual; TAU): non-oscillating hospital-crib mattress. Infants will be studied throughout their hospitalization and post discharge to 14-months of age. The study will compare clinical measures (i.e., withdrawal scores, cumulative dose and duration of medications, velocity of weight gain) and characteristic progression of physiologic activity (i.e., limb movement, cardio-respiratory, temperature, blood-oxygenation) throughout hospitalization between opioid-exposed infants who receive SVS and those who receive TAU. Developmental outcomes (i.e., physical, social, emotional and cognitive) within the first year of life will be evaluated between the two study groups. Findings from this randomized controlled trial will determine whether SVS reduces in-hospital severity of NAS, improves physiologic function, and promotes healthy development.
BACKGROUND: Scoring tools used to quantify withdrawal in infants with neonatal abstinence syndrom... more BACKGROUND: Scoring tools used to quantify withdrawal in infants with neonatal abstinence syndrome (NAS) are often confounded by subjective measurements. This study assessed salivary cortisol as an objective biomarker of withdrawal severity in opioid-exposed newborns. METHODS: A prospective study was conducted in 25 full-term opioid-exposed newborns monitored for NAS. Morning and evening salivary cortisol levels were collected starting within 48 h post birth until initiation of pharmacologic treatment for withdrawal (Pre-Treatment) or when the infant was discharged without pharmacotherapy (No Treatment). RESULTS: Cortisol levels in the Pre-Treatment group (n = 11) were significantly higher within the first week of life (median 1.74 µg/ dl) than in the No Treatment group (n = 11; median 0.72 µg/dl; P = 0.003); three infants had inadequate saliva volume for cortisol assay. Cortisol significantly decreased after 72 h post birth among infants discharged without pharmacotherapy (≤72 h median 1.25 µg/dl; ≥72 h median 0.58 µg/dl; P = 0.022), whereas cortisol remained elevated for infants subsequently treated for severity of withdrawal. No cortisol circadian rhythm was observed for either group. CONCLUSIONS: Salivary cortisol in opioid-exposed newborns may provide an index of stress and help identify infants who will have more severe clinical presentation of NAS. Such a biomarker would allow risk stratification for early treatment and discharge decisions.
OBJECTIVE: Standardized practices for the management of neonatal abstinence syndrome (NAS) are as... more OBJECTIVE: Standardized practices for the management of neonatal abstinence syndrome (NAS) are associated with shorter lengths of stay, but optimal protocols are not established. We sought to identify practice variations for newborns with in utero chronic opioid exposure among hospitals in the Better Outcomes Through Research for Newborns (BORN) network. METHODS: Nursery site leaders completed a survey about hospitals' policies and practices regarding care for infants with chronic opioid exposure ($3 weeks). RESULTS: The 76 (80%) of 95 respondent hospitals were in 34 states, varied in size (<500 to >8000 births and <10 to >200 opioid-exposed infants per year), with most affiliated with academic centers (89%). Most (80%) had protocols for newborn drug exposure screening; 90% used risk-based approaches. Specimens included urine (85%), meconium (76%), and umbilical cords (10%). Of sites (88%) with NAS management protocols, 77% addressed medical management, 72% nursing care, 72% pharmacologic treatment, and 58% supportive care.
barriers 4) participating in quality improvement initiatives. Response rates for pre-and post-imp... more barriers 4) participating in quality improvement initiatives. Response rates for pre-and post-implementation resident surveys were 66% & 55% respectively. 47% pre-vs 60% post-implementation respondents indicated expediting discharges when the hospital was on census alert. 49% vs 61% indicated communicating patient discharge barriers with nursing. 72% vs 84% indicated knowing their patient's medical milestones. CONCLUSION: Pediatric chief residents can serve an important role to drive cultural change in patient flow management. Study of the Flow Chief's impact on patient flow and safety at our hospital is ongoing.
Background-Standardized practices for the management of neonatal abstinence syndrome (NAS) are as... more Background-Standardized practices for the management of neonatal abstinence syndrome (NAS) are associated with shorter lengths of stay, but optimal protocols are not established. Aim-Identify practice variations for newborns with in-utero chronic opioid exposure among hospitals in the Better Outcomes through Research for Newborns (BORN) network. Methods-Nursery site leaders completed a survey about hospitals' policies and practices regarding care for infants with chronic opioid exposure (≥3 weeks). Results-The 76/95 (80%) respondent hospitals were in 34 states, varied in size (<500->8000 births and <10->200 opioid-exposed infants/year), with most affiliated with academic centers (89%). Most (85%) had protocols for newborn drug exposure screening; 95% used risk-based approaches. Specimens included urine (81%), meconium (73%) and umbilical cords (10%). Of sites (88%) with NAS management protocols, 77% addressed medical management, 72% nursing care, 72% pharmacologic treatment and 58% supportive care. Morphine was the most common
most months post-intervention are above the previous mean although the results are again not sign... more most months post-intervention are above the previous mean although the results are again not significant. CONCLUSIONS AND NEXT STEPS: After two PDSA cycles, there was no significant impact of PCP identification on admission, determined to be two standard deviations above the baseline of 59%. There was an upward trend of identifying PCP by name only versus including the address and phone number after the first intervention, however it was not sustained in time. Contributing to less than projected results were non-categorial pediatric residents who not only missed orientations sessions. There was also inadequate buy-in from all residents (categorical pediatrics and non-categorical) across time. The project is continuing for the 2016-2017 academic year with increased emphasis on education including off-service residents.
of feedback that were identified in phase one of the study. This survey, which utilized a 5-point... more of feedback that were identified in phase one of the study. This survey, which utilized a 5-point Likert scale to determine the importance of each feedback item, was sent out electronically to all categorical residents at each academic center. Results were analyzed with the mean and standard deviation for each question calculated. RESULTS: Focus groups were held at 3 sites with 3-10 residents per focus group. Consistent major themes which arose from the focus groups at all sites as desired areas to receive feedback on CC practice included the following categories: patient panel characteristics, quality measures, measures of efficiency in patient care, population management and information on specific patients. For the second phase of the study, 277 residents received the survey with 92 responding (33% response rate). The mean value that residents placed on the importance of each content area is displayed (table ) with 1 being not important at all and 5 being very important. CONCLUSION: Residents are interested in receiving practice habit data from continuity clinic. Presentation of the feedback described may enhance the resident continuity clinic experience and improve overall performance and enhance patient care.
ImportancePharmacologic agents are often used to treat newborns with prenatal opioid exposure (PO... more ImportancePharmacologic agents are often used to treat newborns with prenatal opioid exposure (POE) despite known adverse effects on neurodevelopment. Alternative nonpharmacological interventions are needed.ObjectiveTo examine efficacy of a vibrating crib mattress for treating newborns with POE.Design, Setting, and ParticipantsIn this dual-site randomized clinical trial, 208 term newborns with POE, enrolled from March 9, 2017, to March 10, 2020, were studied at their bedside throughout hospitalization.InterventionsHalf the cohort received treatment as usual (TAU) and half received standard care plus low-level stochastic (random) vibrotactile stimulation (SVS) using a uniquely constructed crib mattress with a 3-hour on-off cycle. Study initiated in the newborn unit where newborns were randomized to TAU or SVS within 48 hours of birth. All infants whose symptoms met clinical criteria for pharmacologic treatment received morphine in the neonatal intensive care unit per standard care.Ma...
Importance Mindfulness curricula can improve physician burnout, but implementation during residen... more Importance Mindfulness curricula can improve physician burnout, but implementation during residency presents challenges. Objective To examine whether a novel mindfulness curriculum implemented in the first 6 months of internship reduces burnout. Design, Setting, and Participants This pragmatic, multicenter, stratified cluster randomized clinical trial of a mindfulness curriculum randomized 340 pediatric interns to the intervention or control arm within program pairs generated based on program size and region. Fifteen US pediatric training programs participated from June 14, 2017, to February 28, 2019. Interventions The intervention included 7 hour-long sessions of a monthly mindfulness curriculum (Mindfulness Intervention for New Interns) and a monthly mindfulness refresher implemented during internship. The active control arm included monthly 1-hour social lunches. Main Outcomes and Measures The primary outcome was emotional exhaustion (EE) as measured by the Maslach Burnout Inventory 9-question EE subscale (range, 7-63; higher scores correspond to greater perceived burnout). Secondary outcomes were depersonalization, personal accomplishment, and burnout. The study assessed mindfulness with the Five Facet Mindfulness Questionnaire and empathy with the Interpersonal Reactivity Index subscales of perspective taking and empathetic concern. Surveys were implemented at baseline, month 6, and month 15. Results Of the 365 interns invited to participate, 340 (93.2%; 255 [75.0%] female; 51 [15.0%] 30 years or older) completed surveys at baseline; 273 (74.8%) also participated at month 6 and 195 (53.4%) at month 15. Participants included 194 (57.1%) in the Mindfulness Intervention for New Interns and 146 (42.9%) in the control arm. Analyses were adjusted for baseline outcome measures. Both arms' EE scores were higher at 6 and 15 months than at baseline, but EE did not significantly differ by arm in multivariable analyses (6 months: 35.4 vs 32.4; adjusted difference, 3.03; 95% CI, -0.14 to 6.21; 15 months: 33.8 vs 32.9; adjusted difference, 1.42; 95% CI, -2.42 to 5.27). None of the 6 secondary outcomes significantly differed by arm at month 6 or month 15. Conclusions and Relevance A novel mindfulness curriculum did not significantly affect EE, burnout, empathy, or mindfulness immediately or 9 months after curriculum implementation. These findings diverge from prior nonrandomized studies of mindfulness interventions, emphasizing the importance of rigorous study design and suggesting that additional study is needed to develop evidence-based methods to reduce trainee burnout. Trial Registration ClinicalTrials.gov Identifier: NCT03148626.
Background Physician burnout affects many physicians and is associated with decreased patient saf... more Background Physician burnout affects many physicians and is associated with decreased patient safety and physician health. Mindfulness curricula can reduce burnout but are often impractical to implement during residency. Objectives: To determine how a novel 6-month mindfulness curriculum designed for pediatric trainees impacts physician burnout, mindfulness, and empathy. Methods 15 pediatric residency programs’ interns participated in a stratified, cluster randomized controlled trial of the “Mindfulness Intervention for New Interns” (MINdI) curriculum. Participants completed the Maslach Burnout Inventory, Five Facet Mindfulness Questionnaire, and 2 Interpersonal Reactivity Index empathy scales and measures of mindfulness-related knowledge, attitudes and behaviors. Burnout was defined as an emotional exhaustion (EE) score >= 27 or a depersonalization (DP) score >= 10. The primary outcome was EE score. Missing data was addressed by conducting 20 data imputations. To determine impact of study arm on outcomes, we conducted logistic and GEE regressions clustered on site while controlling for factors that differed by arm. Results 340/365 invited interns completed the baseline survey (93.1%), and 254 completed follow-up (69.6%). At baseline, the mean EE score of the MINdI and control arms did not significantly differ (coef. -0.25; 95% CI: -4.54, 4.04), but the odds of burnout was significantly higher in the MINdI arm than controls (OR 2.73; 95% CI: 1.005, 7.43). Compared to controls, there were significantly higher mindfulness-related knowledge, attitudes, and behavior and higher EE scores in the MINdI arm at follow-up (coef. 2.45; 95% CI: 0.90, 6.66). At follow-up, burnout, mindfulness, or empathy scores did not significantly differ by arm. Conclusion Interns randomized to experience MINdI had higher EE despite increased knowledge, attitudes, and behaviors about mindfulness. The MINdI curriculum did not affect burnout, mindfulness nor empathy. As the curricula improved some measures of learning but increased EE future rigorous study of curricula to reduce physician burnout is needed.
most months post-intervention are above the previous mean although the results are again not sign... more most months post-intervention are above the previous mean although the results are again not significant. CONCLUSIONS AND NEXT STEPS: After two PDSA cycles, there was no significant impact of PCP identification on admission, determined to be two standard deviations above the baseline of 59%. There was an upward trend of identifying PCP by name only versus including the address and phone number after the first intervention, however it was not sustained in time. Contributing to less than projected results were non-categorial pediatric residents who not only missed orientations sessions. There was also inadequate buy-in from all residents (categorical pediatrics and non-categorical) across time. The project is continuing for the 2016-2017 academic year with increased emphasis on education including off-service residents.
The incidence of Neonatal Abstinence Syndrome (NAS) continues to rise and there remains a critica... more The incidence of Neonatal Abstinence Syndrome (NAS) continues to rise and there remains a critical need to develop non-pharmacological interventions for managing opioid withdrawal in newborns. Objective physiologic markers of opioid withdrawal in the newborn remain elusive. Optimal treatment strategies for improving shortterm clinical outcomes and promoting healthy neurobehavioral development have yet to be defined. This dualsite randomized controlled trial (NCT02801331) is designed to evaluate the therapeutic efficacy of stochastic vibrotactile stimulation (SVS) for reducing withdrawal symptoms, pharmacological treatment, and length of hospitalization, and for improving developmental outcomes in opioid-exposed neonates. Hospitalized newborns (n = 230) receiving standard clinical care for prenatal opioid exposure will be randomly assigned within 48hours of birth to a crib with either: 1) Intervention (SVS) mattress: specially-constructed SVS crib mattress that delivers gentle vibrations (30-60 Hz, ~12 μm RMS surface displacement) at 3-hr intervals; or 2) Control mattress (treatment as usual; TAU): non-oscillating hospital-crib mattress. Infants will be studied throughout their hospitalization and post discharge to 14-months of age. The study will compare clinical measures (i.e., withdrawal scores, cumulative dose and duration of medications, velocity of weight gain) and characteristic progression of physiologic activity (i.e., limb movement, cardio-respiratory, temperature, blood-oxygenation) throughout hospitalization between opioid-exposed infants who receive SVS and those who receive TAU. Developmental outcomes (i.e., physical, social, emotional and cognitive) within the first year of life will be evaluated between the two study groups. Findings from this randomized controlled trial will determine whether SVS reduces in-hospital severity of NAS, improves physiologic function, and promotes healthy development.
BACKGROUND: Scoring tools used to quantify withdrawal in infants with neonatal abstinence syndrom... more BACKGROUND: Scoring tools used to quantify withdrawal in infants with neonatal abstinence syndrome (NAS) are often confounded by subjective measurements. This study assessed salivary cortisol as an objective biomarker of withdrawal severity in opioid-exposed newborns. METHODS: A prospective study was conducted in 25 full-term opioid-exposed newborns monitored for NAS. Morning and evening salivary cortisol levels were collected starting within 48 h post birth until initiation of pharmacologic treatment for withdrawal (Pre-Treatment) or when the infant was discharged without pharmacotherapy (No Treatment). RESULTS: Cortisol levels in the Pre-Treatment group (n = 11) were significantly higher within the first week of life (median 1.74 µg/ dl) than in the No Treatment group (n = 11; median 0.72 µg/dl; P = 0.003); three infants had inadequate saliva volume for cortisol assay. Cortisol significantly decreased after 72 h post birth among infants discharged without pharmacotherapy (≤72 h median 1.25 µg/dl; ≥72 h median 0.58 µg/dl; P = 0.022), whereas cortisol remained elevated for infants subsequently treated for severity of withdrawal. No cortisol circadian rhythm was observed for either group. CONCLUSIONS: Salivary cortisol in opioid-exposed newborns may provide an index of stress and help identify infants who will have more severe clinical presentation of NAS. Such a biomarker would allow risk stratification for early treatment and discharge decisions.
OBJECTIVE: Standardized practices for the management of neonatal abstinence syndrome (NAS) are as... more OBJECTIVE: Standardized practices for the management of neonatal abstinence syndrome (NAS) are associated with shorter lengths of stay, but optimal protocols are not established. We sought to identify practice variations for newborns with in utero chronic opioid exposure among hospitals in the Better Outcomes Through Research for Newborns (BORN) network. METHODS: Nursery site leaders completed a survey about hospitals' policies and practices regarding care for infants with chronic opioid exposure ($3 weeks). RESULTS: The 76 (80%) of 95 respondent hospitals were in 34 states, varied in size (<500 to >8000 births and <10 to >200 opioid-exposed infants per year), with most affiliated with academic centers (89%). Most (80%) had protocols for newborn drug exposure screening; 90% used risk-based approaches. Specimens included urine (85%), meconium (76%), and umbilical cords (10%). Of sites (88%) with NAS management protocols, 77% addressed medical management, 72% nursing care, 72% pharmacologic treatment, and 58% supportive care.
barriers 4) participating in quality improvement initiatives. Response rates for pre-and post-imp... more barriers 4) participating in quality improvement initiatives. Response rates for pre-and post-implementation resident surveys were 66% & 55% respectively. 47% pre-vs 60% post-implementation respondents indicated expediting discharges when the hospital was on census alert. 49% vs 61% indicated communicating patient discharge barriers with nursing. 72% vs 84% indicated knowing their patient's medical milestones. CONCLUSION: Pediatric chief residents can serve an important role to drive cultural change in patient flow management. Study of the Flow Chief's impact on patient flow and safety at our hospital is ongoing.
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