81 Evaluation of the Impact of the S.T.A.B.L.E. Program on the Pre-Transport Care of the Neonate in Nova Scotia

Abstract

The S.T.A.B.L.E. Program is a standardized educational program focusing on the stabilization of the critically ill neonate prior to transport. The S.T.A.B.L.E. Program was implemented over 13 months in all referring centers (12) providing obstetrical services in Nova Scotia in 1999. The program has been widely implemented in the United States but has not been previously evaluated. To assess if the S.T.A.B.L.E. Program increases regional healthcare provider perceived confidence in pre-transport stabilization; to determine if the S.T.A.B.L.E. Program guidelines are incorporated into healthcare provider clinical practice; and to assess if the pre-transport management of neonates has improved. A retrospective chart review of all Nova Scotia neonates transported to the NICU at the IWK Health Centre in two time periods (pre- and post-S.T.A.B.L.E. implementation). Information obtained included birthweight, gestation and time spent at the referring center by the Neonatal Transport Team. An analysis of interventions based on S.T.A.B.L.E. guidelines begun by the referring Centre in the two time periods was performed. A questionnaire utilizing a Likert scale was sent to all healthcare providers in Nova Scotia who had participated in the S.T.A.B.L.E. Program during the initial 13 months, to evaluate participant satisfaction, self-perceived confidence and change in practice. 64/124 (52%) questionnaires were completed. Nearly all participants (96%) indicated the course was relevant and useful. 90% indicated that they felt more confident in neonatal pre-transport stabilization, and 86.5% indicated that they had adopted principles of the S.T.A.B.L.E. Program into their practice. 127 charts of infants transported to the NICU were reviewed: 80 pre-S.T.A.B.L.E., 47 post-S.T.A.B.L.E. There were no differences in birth-weight or gestation between the two groups. There were no differences found between the two groups for: improved glucose, thermoregulation, BP stability, increased intubation if needed or for stabilization time required on arrival of the Neonatal Transport Team. Although this study did not find an improvement in clinical outcome, it highlights the increase in provider confidence since the S.T.A.B.L.E. Program was implemented. As this study was carried out in a region with a well established regionalized healthcare system with strong prenatal referral patterns for premature infants, further evaluation of the S.T.A.B.L.E. Program in regions with higher rates of outborn deliveries is warranted.