G223(P) Avoiding term admissions into neonatal units: how do we best identify areas for improvement

Publication Summary

Aims ATAIN (Avoiding Term Admissions Into Neonatal units) is an NHS England Quality Improvement initiative to reduce admission of full-term babies to neonatal care. All term admissions are collaboratively reviewed by neonatal and maternity teams to identify avoidable admissions and areas to focus quality improvement. We aimed to review our term admissions using the guidance for clinical review team questions (GCRTQs) published in NHS Improvement’s ‘Reducing harm leading to avoidable admission of full-term babies into neonatal units: findings and resources for improvement.’ Methods All term (>37 weeks) admissions to the neonatal unit between April and June 2018 were identified. Badger and notes documentation was collaboratively reviewed and compared to the GCRTQs for respiratory symptoms, jaundice and hypoglycaemia. Results 50 babies were identified. 31/50 (62%) had respiratory symptoms. One baby was born by elective c-section before 39 weeks (with appropriate medical indication). 11/31 did not require respiratory intervention to warrant separation. However, 6 of these had evidence of infection, 1 had a moderate pneumothorax, 1 had recurrent dusky episodes, and 1 had a cleft palate. 2 were subsequently noted to have other problems (early jaundice and hypoglycaemia). None were deemed appropriate for transitional care (TC) at admission. Length of stay ranged from 1 to 11 days. No admissions were for default concerns, and intrapartum antibiotics were given appropriately. 3/50 (6%) were jaundiced. Two were less than 24 hours old and all required high-intensity phototherapy. One Mum had refused anti-D. 2/50 (4%) were hypoglycaemic. Both had risk factors, other associated clinical signs and required IV dextrose. Neither was hypothermic. The GCRTQs did not identify other issues for babies with jaundice or hypoglycaemia. 13/50 (26%) were admitted for other reasons (of whom 6 had bilious vomiting, and 3 required observation for neonatal abstinence with associated social issues). Conclusion The GCRTQs did not identify specific clinical insights in our tertiary neonatal unit, which has relatively low term admission rates and well-established transitional care facilities. We suggest in such settings, rather than review of all term admission using GCRTQs, areas for quality improvement are more likely to be identified through collaborative review of clinical incidents related to term admissions, near-misses and unexpected term TC admissions.