Decreasing Neonatal Intensive Care Unit Length of Stay in Infants with Neonatal Abstinence Syndrome
Rachel Cone, Diana McDaniel, Lucy Roberts, Catherine Sprucebank, & Robin Stout
Bon Secours Memorial College of Nursing
Abstract
Description of the Issue: A lack of
non-pharmacological scoring procedures and
interventions impact the length of stay (LOS) in infants
with neonatal abstinence syndrome (NAS). St. Francis
Medical Center (SFMC) wishes to reduce the length of
stay in its neonatal intensive care unit (NICU) and asks
for proposed solutions. The aim of this project is to
see how nurse education on a non-pharmacological
Eat, Sleep, Console Model (ESC) can decrease LOS in
infants with NAS.
Data Analysis: Data was collected from conversations
with the NICU liaison and from the literature.
Root Cause: A lack of standardized,
non-pharmacological guidelines and education related
to the ESC Model was identified as a root cause for
prolonged LOS for infants with NAS.
Proposed Solution: Encourage parents to utilize the
ESC model and provide them with education on the
ESC model. Education will be utilized through a
brochure that can also be used for nursing staff.
Conclusion: Implementation of the ESC model and
nonpharmacological methods will reduce NICU LOS in
infants with NAS.
Introduction and Description of
the Issue
Macro Description: An extended LOS for infants in
the neonatal intensive care unit (NICU) is a
stressful experience for both the neonate and the
family. NICU infants with neonatal abstinence
syndrome (NAS) often have greater length of stays,
higher health care costs, and more pharmacologic
interventions than average infants without NAS.
Nonpharmacologic interventions and standardized
scoring measures can reduce LOS in this population
and improve outcomes (Walsh et al., 2018).
Micro Description: SFMC wishes to utilize the Eat,
Sleep, Console Model (ESC) in its NICU to reduce
the length of stay for babies with NAS. The hospital
reported that the average length of stay for infants
with NAS is 7 days (Nickle, personal communication, 2021).
Data and Analysis of the Issue
Based on 2016 data from Healthcare Cost &
Utilization Project:
The cost of a hospital stay for a newborn with
●
NAS was $9,500 in 2016, compared with $1,100
for other newborn hospital stays—a nearly
9-times increase in cost. The average length of
stay for a newborn with NAS was 12 days in
2016, compared with 2 days for other newborn
hospital stays—a 6-times increase in length of
stay (CDC, 2021).
● Total overall hospitalization costs was $572.7
million for infants with NAS (Strahan et al., 2019).
The NICU liasion reported:
● A drastic drop in length of stay and decrease
usage of pharmacological treatment when
rooming in with parents, exclusive
breastfeeding, music therapy, sensitive formula
if desire to formula feed, low stimulus
environment, and skin to skin were used (Nickle,
personal communication, 2021).
Root Cause
There are no standardized guidelines on using
non-pharmacological interventions, such as the ESC
model, to reduce LOS in infants with NAS.
(Dodds et al., 2019).
Hypothesis: Since the St. Francis NICU is
transitioning to the ESC model of care, consistent
use of the model and nonpharmacological
methods should lead to a decrease in LOS.
Therefore, we suggest educating nurses on how to
properly implement the ESC model of care to
reduce the LOS.
Proposed
AIM Solution
- Proposed Solution Conclusion
● There is currently no specific protocol at SFMC
Reducing the average LOS for NICU infants with
regarding the use of the ESC model.
NAS from 7 days to 5 days by December 2021. We
● Dodds et al. (2019) noted successful
will develop educational resources for parents and implementation of the ESC model with resultant
nurses to help transition. decreased LOS, decreased medication use, and
cost savings.
● Ensuring proper education on the ESC model of
Logistics: care and nonpharmacological methods for
- During shift huddle, staff will be educated
to implement this model. nurses and families alike will result in a
- Informational ESC pamphlets will be decreased LOS for NICU infants with NAS.
distributed to nursing staff and family.
- Families will be assessed on their clarity
prior to discharge on the ESC model.
Stakeholders:
- NICU infants and their families
- NICU, labor and delivery, &
mother/infant nurses
- Neonatologists, NNPs, OBGYNs
- Case managers
References
Asti, L., Magers, J. S., Keels, E., Wispe, J., & McClead, R. E., Jr
Potential Costs: (2015). A quality improvement project to reduce length of stay
- Printing is around $0.10 per page x 100
pages for neonatal abstinence syndrome. Pediatrics, 135(6),
- Total cost will be around $10. e1494–e1500. 10.154. doi:2/peds.2014-1269
CDC. (2021). Data and statistics about opioid use during
pregnancy. https://www.cdc.gov/pregnancy/opioids/data.html
Timeline:
- April 21, 2021 QI project to be presented Dodds, D., Koch, K., Buitrago-Mogollon, T., & Horstmann, S.
with proposed solution (2019). Successful implementation of the eat sleep console
- May 1, 2021 pamphlets to be discussed model of care for infants with NAS in a community hospital.
and handed out to staff
- June 1, 2021 nurses will begin Hospital Pediatrics, 9(8), 632-638. doi:10.1542/hpeds.2019-0
implementing ESC model into practice
- December 1, 2021 NICU LOS will be
remeasured Strahan A. E., Guy G. P., Bohm, M., Frey, M., & Ko, J. Y. (2019).
Neonatal Abstinence Syndrome incidence and health care costs
in the United States. JAMA Pediatrics, 174(2), 200–202.
Data Collection: doi:10.1001/jamapediatrics.2019.4791
- Monthly data on the LOS for NICU
infants
- Chart reviews to determine consistency
of staff use of the ESC method in Walsh, M. C., Crowley, M., Wexelblatt, S., Ford, S., Kuhnell, P.,
September 2021 Kaplan, H. C., & Lannon, C. (2018). Ohio perinatal quality
- Collected by unit management collaborative improves care of neonatal Narcotic Abstinence
Syndrome. Pediatrics, 141(4). doi:10.1542/peds.2017-0900