Term admissions to neonatal units in England: A role for transitional care? A retrospective cohort study (2017)

Type of publication:
Journal article

Author(s):
Battersby C.; Michaelides S.; Upton M.; Rennie J.M.; Babirecki M.; Harry L.; Rackham O.; Wickham T.; Hamdan S.; Gupta A.; Wigfield R.; Wong L.; Mittal A.; Nycyk J.; Simmons P.; Singh A.; Seal S.; Hassan A.; Schwarz K.; Thomas M.; Foo A.; Shastri A.; Whincup G.; Brearey S.; Chang J.; Gad K.; Hasib A.; Garbash M.; Allwood A.; Adiotomre P.; Ahmed J.S.; Deketelaere A.; Khader K.A.; Shephard R.; Mallik A.; Abuzgia B.; Jain M.; Pirie S.; Zengeya S.; Watts T.; Jampala C.; Seagrave C.; Cruwys M.; Dixon H.; Aladangady N.; Gaili H.; James M.; Lal M.; Ambadkar; Rao P.; Hickey A.; Dave D.; Pai V.; Lama M.; Miall L.; Cusack J.; Kairamkonda V.; Jayachandran; Kollipara; Kefas J.; Yoxall B.; Whitehead G.; Krishnamurthy; Soe A.; Misra I.; Pillay T.; Ali I.; Dyke M.; Selter M.; Panasa N.; Alsford L.; Spencer V.; Gupta S.; Nicholl R.; Wardle S.; McBride T.; Shettihalli N.; Adams E.; Babiker S.; Crawford M.; Gibson D.; Khashu M.; Toh C.; Hall M.; Sleight E.; Groves C.; Godambe S.; Bosman D.; Rewitzky G.; Banjoko O.; Kumar N.; Manzoor A.; Lopez W.; D’Amore A.; Mattara S.; Zipitis C.; De Halpert P.; Settle P.; Munyard P.; McIntyre J.; Bartle D.; Yallop K.; Fedee J.; Maddock N.; Gupta R.; *Deshpande S.; Moore A.; Godden C.; Amess P.; Jones S.; Fenton A.; Mahadevan; Brown N.; Mack K.; Bolton R.; Khan A.; Mannix P.; Huddy C.; Yasin S.; Butterworth S.; Edi-Osagie N.; Cairns P.; Reynolds P.; Brennan N.; Heal C.; Salgia S.; Abu-Harb M.; Birch J.; Knight C.; Clark S.; Van Sommen V.; Murthy V.; Paul S.; Kisat H.; Kendall G.; Blake K.; Kuna J.; Kumar H.; Vemuri G.; Rawlingson C.; Webb D.; Bird; Narayanan S.; Gane J.; Eyre E.; Evans I.; Sanghavi R.; Sullivan C.; Amegavie L.; Leith W.; Vasu V.; Gallagher A.; Vamvakiti K.; Eaton M.; Millman G.

Citation:
BMJ Open; May 2017; vol. 7 (no. 5)

Abstract:
Objective: To identify the primary reasons for term admissions to neonatal units in England, to determine risk factors for admissions for jaundice and to estimate the proportion who can be cared for in a transitional setting without separation of mother and baby. Design: Retrospective observational study using neonatal unit admission data from the National Neonatal Research Database and data of live births in England from the Office for National Statistics. Setting: All 163 neonatal units in England 2011-2013. Participants: 133 691 term babies born >=37 weeks gestational age and admitted to neonatal units in England. Primary and secondary outcomes: Primary reasons for admission, term babies admitted for the primary reason of jaundice, patient characteristics, postnatal age at admission, total length of stay, phototherapy, intravenous fluids, exchange transfusion and kernicterus. Results: Respiratory disease was the most common reason for admission overall, although jaundice was the most common reason for admission from home (22% home vs 5% hospital). Risk factors for admission for jaundice include male, born at 37 weeks gestation, Asian ethnicity and multiple birth. The majority of babies received only a brief period of phototherapy, and only a third received intravenous fluids, suggesting that some may be appropriately managed without separation of mother and baby. Admission from home was significantly later (3.9 days) compared with those admitted from elsewhere in the hospital (1.7 days) (p<0.001). Conclusion: Around two-thirds of term admissions for jaundice may be appropriately managed in a transitional care setting, avoiding separation of mother and baby. Babies with risk factors may benefit from a community midwife postnatal visit around the third day of life to enable early referral if necessary. We recommend further work at the national level to examine provision and barriers to transitional care, referral pathways between primary and secondary care, and community postnatal care

Link to full-text: http://bmjopen.bmj.com/content/7/5/e016050

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Improving documentation of communication with parents in neonatal unit. A service development experience (2016)

Type of publication:
Conference abstract

Author(s):
Kasim Aldaleel O., *Welch R.

Citation:
Archives of Disease in Childhood, April 2016, vol./is. 101/(A71-A72)

Abstract:
Introduction Effective communication with parents/patients is essential according to Domain 3 of the General Medical Council’s (GMC) Guide for Good Medical Practice. Documentation of communication is crucial for clinical and medicolegal aspects. A local survey in our unit revealed a room for development, when 35.3% only of communication with parents was documented. Aim To improve documentation of communication with parents in the neonatal unit, in line with GMC Good Medical Practice Guide, aiming at 100% documentation of communications with parents. Method A development team was assigned with clear responsibilities and leadership. As part of PDSA (Plan-Do-Study-Act) cycle for improvement, tools were developed as an Act to improve documentation of communication with parents. The developed tools were; making documentation of communication with parents a handover component, making the documentation in the notes a personal responsibility of the doctor who spoke to parents and recording that, creating posters about documenting communication with parents and distributing them in different areas of the department as reminders and having a weekly updated Statistical Process Control chart (SPC chart) clearly visible in the unit. Results A Test of the Change was carried out after 2 months by a review of the last 6 weeks of the SPC Chart. The overall percentage of documented communication with parents was 72.85% (51/70) over 6 weeks period. The first week did not show significant change when 36% (4/11) of communications were documented. However, there was a steady improvement between the second and the fifth weeks, ranging from 71% to 80%, before reaching 92% in the sixth week. That was a positive test of change which was highlighted and implementation of these tools was agreed. High quality documented communications were selected and presented to trainees for learning benefits. Conclusion Having accurate medical records is medicolegally essential. Developing local tools to improve documentation of communication with parents is important when that documentation is sub-optimal. The SPC chart, posters, and communication documentation handing over are effective tools. However, other tools might be effective depending on each unit’s needs.