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NICUs: What is a small baby unit?

Small baby units take the neonatal intensive care unit (NICU) concept to a new level by specializing in the care of the smallest babies – known as micro-preemies – born at fewer than 27 weeks gestation and/or weighing less than 1,000 grams (2.2 pounds).  The design of the units, which are part of a larger NICU, includes providing a dark, quiet environment.  Parents are encouraged to participate in skin-to-skin care (SSC) techniques that fosters bonding, such as Kangaroo Mother Care.  Caregivers are teamed up to deliver two-person care when the micro-preemies need to be touched.  As the babies grow, they may be transitioned out of the small baby unit to the NICU.

Hospitals with Small Baby Units (this is not a comprehensive list)

  • Advocate Lutheran General Hospital (Park Ridge, IL)
  • Children’s Hospital (Orange, CA)
  • Greenville Health System (Greenville, SC)
  • Helen Devos Children’s Hospital (Grand Rapids, MI)
  • Mercyhealth Hospital-Rockton Avenue (Rockford, IL)
  • Nationwide Children’s Hospital (Columbus, OH)

Sources:

Gonya, J., and others. (2017). Investigating skin-to-skin care patterns with extremely preterm infants in the NICU and their effect on early cognitive and communication performance: A retrospective cohort study. BMJ Open, 7.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372108/pdf/bmjopen-2016-012985.pdf

GHS launches NICU small baby unit. (2017, May 12). WSPA-TV. http://wspa.com/2017/05/12/ghs-launches-nicu-small-baby-unit/

Jackson, A. (2015, December 9).  Born at 25 weeks weighing less than 2 pounds, ‘spunky’ girl survives in small baby unit. MLive. http://www.mlive.com/news/grand-rapids/index.ssf/2015/12/small_baby_nicu_at_devos_child.html

Morris, M., Cleary, P., and Soliman, A. (2015, October). Small baby unit improves quality and outcomes in extremely low birth weight infants. Pediatrics, 136(4).  http://pediatrics.aappublications.org/content/pediatrics/136/4/e1007.full.pdf

Watley, K. (2017, February 6). Mercyhealth in Rockford opens region’s first small baby unit to care for micro-preemies. https://mercyhealthsystem.org/mercyhealth-opens-small-baby-unit-rockford/

Woloshyn, E. (2017, April 20). Special unit mimics mother’s womb. Health enews.

http://www.ahchealthenews.com/2017/04/20/special-unit-mimics-mothers-womb/  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

ISOLATION ROOMS: How many air changes per hour?

Design considerations for negative isolation and positive isolation rooms are discussed in this brief article by an engineering consultant.  Negative-pressure isolation rooms are intended to keep an infectious patient from infecting others in the hospital.  Positive isolation rooms are the opposite – intended to keep germs away from an immunocompromised patient in the room.  The recommendation for both types of isolation rooms is reported to be at least 12 air changes per hour.  Some hospitals use isolation rooms for general patients when they are available.  Although allowed in the past, it is no longer possible to operate isolation rooms that can be switched back and forth from negative to positive pressure.

Source: Herrick, M. (2017, February). Pressure points: Planning and maintaining air isolation rooms. Health Facilities Management, 30(2), 29-32.  Click here: http://www.hfmmagazine.com/articles/2671-planning-and-maintaining-hospital-air-isolation-rooms  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

PATIENT SAFETY: Handoffs between ICU and OR

There is a lot of literature describing problems with, and best practices for, the transfer of care of post-surgical patients moving into the intensive care unit setting.  However, after conducting a comprehensive literature search, the authors of this brief commentary found no comparable literature about the reverse type of handoff – for patients going from the special care unit into surgery.  They suggest that a checklist be adopted and give an example of one such checklist.  They also recommend that a verbal handoff be required.

What do I like about this article?  The authors are authoritative (Mount Sinai and Johns Hopkins medical schools) and I like the actual example of the handoff checklist.  Also, I like it that they appear to be filling a gap in the medical literature – at least at the time that they wrote this commentary.

Source: Evans, A.S., Yee, M.S., and Hogue, C.W. (2014, Mar.). Often overlooked problems with handoffs: From the intensive care unit to the operating room.  Anesthesia & Analgesia, 118(3), 687-689.  Click here for free full text: http://journals.lww.com/anesthesia-analgesia/Fulltext/2014/03000/Often_Overlooked_Problems_with_Handoffs___From_the.31.aspx  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

ICUs: How do high-performing hospitals reduce CLABSI rates?

This is a study out of Johns Hopkins of 17 intensive care units at 7 hospitals – comparing practices related to reducing the central line-associated bloodstream infection (CLABSI) rate.  High performers were defined as those with less than 1 infection per 1000 catheter-days over the period of at least one year.  Low performers were defined as having over 3 infections per 1000 catheter-days.

I particularly like the tables and the appendices to this article.  The tables identify characteristics of high-performers in bullet-point brevity for each of the following levels of hospital employees: senior leadership, ICU managers, infection prevention and quality improvement staff, and frontline staff.  The appendices contain specific questions that make up a CLABSI Conversation – again differentiated between senior management, infection control / quality improvement staff, and ICU staff.

Source: Pham, J.C., and others. (2016, Apr.-June). CLABSI Conversations: Lessons from peer-to-peer assessments to reduce central line-associated bloodstream infections. Quality Management in Health Care, 25(2), 67-78.  Click here for publisher’s website:  http://journals.lww.com/qmhcjournal/pages/articleviewer.aspx?year=2016&issue=04000&article=00001&type=abstract  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

NICU: Length of stay 109 days for technology-dependent babies at Rainbow Babies & Children’s

What is this study? A retrospective medical record review for 93 babies discharged from NICU at one hospital.

More about it: Researchers studied the care needed by babies who were discharged home from the neonatal intensive care unit at Rainbow Babies & Children’s Hospital (Cleveland) during a recent two- year period.  Data on 71 babies who were technology dependent were compared with 22 who were not.  Here are some findings:

Technology-Dependent Newborns Discharged from NICU

  • 66 percent needed supplemental oxygen at home
  • 46 percent needed feeding tubes at home
  • 16 percent needed tracheostomy at home
  • 16 percent needed mechanical ventilation at home

Newborns discharged home dependent on technology had an initial stay in the NICU of about 109 days compared to about 26 days for those discharged home non-dependent on technology.

Hospital readmission risk indicators for the technology-dependent group included: being female, having a gastrostomy tube or having initial lengthy NICU stay.

Sources:

NICU-t0-home transition can be tricky. (2016, June). Managed Care, 25(6), 8.  Click here: http://www.managedcaremag.com/archives/2016/6/nicu-home-transition-can-be-tricky

Toly, V.B., and others. (2016, June 7). Neonates and infants discharged home dependent on medical technology: Characteristics and outcomes. Advances in Neonatal Care,   Click here:  http://journals.lww.com/advancesinneonatalcare/pages/articleviewer.aspx?year=9000&issue=00000&article=99928&type=abstract

ICU: Wearing gowns and gloves for all ICU patients studied

Caregivers entering patient rooms in intensive care units typically use contact precautions – putting on gowns and gloves – when the patient is known to have antibiotic-resistant bacteria.  This study was a randomized trial of universal gown and glove use for adult patients in intensive care units in 2012.  Data on 1800 patients at different hospitals were studied.  The authors comment that:

  • “The observation that universal glove and gown use may result in fewer adverse events was unanticipated.  Universal glove and gown use could potentially have led to a decrease in HAIs [healthcare-associated infections] by serving as a barrier to acquiring new bacteria both through physical use of gloves and gowns as well as fewer HCW [health care worker] visits and better hand hygiene.”

Source: Croft, L.D., Harris, A.D., Pineles, L., and others. (2015, Aug. 15). The effect of universal glove and gown use on adverse events in intensive care unit patients. Clinical Infectious Diseases, 61(4), 545-553.  Click here for full text: cid.oxfordjournals.org/content/61/4/545.full.pdf  Posted by AHA Resource Center (312) 422-2003, rc@aha.org

 

TRANSPORT: Mayo Clinic improved ICU to OR transports

Patient transportation from critical care unit to the operating room was studied over the 2006 to 2010 period.  During this period there were 1,557 such transfers, some done in the existing traditional way, others according to a new coordinated patient transport system (CPTS).  The transfers studied were only those involving the first surgical case of the day.  Here are the findings:

  • “We report a significant improvement in on-time OR starts when a CPTS is used for all ICU patients who require surgery as a first case of the day.  A CPTS resulted in a fourfold improvement in one-time OR start percentage.” (page 359).

The difference between the traditional patient transport and the new CPTS are described in this article.

Source: Brown, M.J., Kor, D.J., Curry, T.B., and others. (2015, Nov.-Dec.). A coordinated patient transport system for ICU patients requiring surgery: Impact on operating room efficiency and ICU workflow. Journal for Healthcare Quality, 37(6), 354-362. Link to publisher’s website: http://journals.lww.com/jhqonline/Abstract/2015/11000/A_Coordinated_Patient_Transport_System_for_ICU.4.aspx Posted by AHA Resource Center (312) 422-2050, rc@aha.org