Transcript Family Integrated Care
Changing the Paradigm of Neonatal Care
Shoo Lee, MBBS, FRCPC, PhD Paediatrician-in-Chief, Mount Sinai Hospital; Professor of Paediatrics, Obstetrics & Gynecology, and Public Health, University of Toronto; Scientific Director, Institute of Human Development, Child & Youth Health, Canadian Institutes of Health Research
Conflict of Interest
• None to declare
Canadian Neonatal Network
TM Founded 1995
Edmonton Quebec City St John’s Victoria Vancouver New Westminster Calgary Moncton Saskatoon Sherbrooke Fredericton Regina Montreal Winnipeg St John Ottawa Halifax Kingston Toronto London Hamilton
“Improve care through research”
Neonatal Outcomes 1960-2000
1960-1985 1990-2000
Source: Congress of USA, Office of Tech Assessment, NTIS order #PB88-158902 4
EPIQ Conceptual Model
Published evidence Evidence reviews Clinical studies/trials Evidence Process Data Context Outcomes Data Facilitation Local data Best practice examples Practice guidelines Organizational culture Individual behavior Barriers to change Leadership Change management Facilitation tools
THE EPIQ PROJECT
- Transforming Care through Clinical & Implementation Research
Reduced Mortality, Morbidity and Hospital Length of Stay in Canadian Neonatal Intensive Care Units OBJECTIVE
• Reduce mortality, major morbidity and hospital length of stay in NICU
PROJECT
• Pilot project in 12 sites outlining new practices for care • National scale-up of the new practices, implemented in 30 hospitals and 17 universities across Canada
OUTCOMES (3 years)
• 30% decrease in severe eye disease causing blindness • 30% decrease in hospital acquired infection • 30% decrease in severe intestinal infection with high mortality • 2 days average reduction in length of hospital stay • $7-10M annual cost savings Lee SK, Canadian Neonatal Network EPIQ Study Group,
CMAJ 2009. DOI 10.1503/cmaj.081727
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Family Integrated Care
Family Integrated Care
The Estonian Model
Caring for Families
Mothers health and wellbeing is considered essential to the baby’s wellbeing: - midwife - psychologist - physician • Atmosphere of team support; • Mother and baby are a unit, • Nurse partners mother in the baby’s care
Estonia NICU Care Model
Parents are Primary Care-Givers, not nurses Parents responsible for all care except IV, medication Parents participate in rounds, reports, charting Encourage developmental & kangaroo care Nurses are teachers and consultants Results = 30% reduction in NI 30% improvement in weight gain 20% reduction in LOS 50% reduction in nurse utilization improved parent/staff satisfaction
Current Family Centered Care
Family Baby Nurse Doctor Therapist
Family Integrated Care
Nurse Doctor Therapist Parent Volunteer
Family Integrated Care Pilot
• Funded by AHFMR/MOHLTC • Formative pilot at Mt Sinai 2011 • Eligible patients = CPAP or less support • Parents and Providers as planning co-leads • Tremendous support from parent volunteers • Planning, protocols, training modules, ethics, legal completed • 40 families
Family Integrated Care Pilot Results Mount Sinai Hospital, Toronto
• 25% improvement in weight gain • • Decreased nosocomial infection - from 11.5% to zero Reduced critical incident reports - from 10% to zero • Decreased parental stress • • CIHR funding for cluster randomized controlled trial at 16 hospitals NCE application for KT to all Level 2 NICUs
NEC Strategies
The Japanese Way
5 4 1 0 3 2 8 7 6
NEC Incidence: Canada & Japan
Canada Japan NEC Incidence (%)
Japan NEC Strategy
Exclusive breast milk feeding for <28 weeks Aggressive feeding – full feeds in one week Avoid umbilical catheters Early use of PIC lines to reduce skin breaks Use antibiotics only if evidence of infection Transpyloric feeding catheters Formula Breast Milk Minimal handling 2 Encourage developmental & kangaroo care 0 Hosp A Hosp B
Breast Milk for All Babies
Vancouver Winnipeg Calgary Montreal Halifax Toronto
“Back to Basics – learn to respect Nature”
Health System Implications
Milk Bank Parents Provide Care
FAMILY INTEGRATED CARE
Appropriate use Of technology GentleR Developmental care Improved feeding Enhanced Follow-Up Re-develop Facilities Re-organize Perinatal regionalization Change in roles Fewer staff Re-train staff Improved outcomes Reduced costs
With acknowledgements:
Canadian Neonatal Network Canadian Institutes of Health Research Michael Smith Foundation for Health Research Ontario Ministry of Health & Long Term Care Participating Institutions