Adoption of the Rapid Response Team Model of Care for Infants

Abstract

In reviewing NICU transfers from postpartum unit, we found that some infants received care within the scope of the postpartum unit. These unnecessary transfers caused significant, preventable stress to families and directly affected mother–newborn bonding. Alternatively, postpartum staff reported feeling overwhelmed because of increased workload and the inherent complexity of providing care to high-risk patients when they remained in the postpartum unit. To incorporate a situational awareness tool, modeling the hospital’s adult rapid response team (RRT) program to identify high-risk neonates. To develop a system of surveillance and regular communication between the NICU and postpartum unit regarding care of these newborns. To offer necessary support to postpartum staff to keep high-risk newborns with their mothers when appropriate. A stakeholder group implemented the Watcher program. Initially, we found postpartum staff were overwhelmed, leading to scaling back and enacting incremental change. The first change included an introduction of the situational awareness model and designating newborns as “watchers” in the situational awareness tab in Epic. We then incorporated the support and surveillance of these newborns from the NICU team, largely coming in the form of regularly scheduled huddles to discuss care concerns or difficulties, developing a plan of care, and hands-on care assistance from NICU when needed. Although this program is still evolving, in the 4 months since implementation, identification of high-risk newborns has increased to 32 per month, whereas transfers to our NICU decreased by 35% compared with the same period in 2017. This program keeps mothers and babies together and is a cost-saving measure for the hospital. In addition, postpartum unit charge nurses have reported that this tool has improved their ability to create more equitable assignments, which has led to improved nursing satisfaction. Many high-reliability organizations have adopted a situational awareness tool in their adult populations, yet we found no evidence of a tool being used in a neonatal population. We believe that implementation of a similar program in other postpartum and NICU arenas will produce the same benefits we experienced.