Utilization of Occupational and Physiotherapy Services in a Level 4 NICU and Neurodevelopment Follow-Up Clinics: a Quality Improvement Study

Abstract

<h3>Research Objectives</h3> Neonates in the NICU are at risk of neuromotor & behavioral impairments & regular follow-up with multidisciplinary team can optimize the development. 1-30 Physiotherapy (PT) & Occupational therapy (OT) services are available in the Women's Wellness & Research Center (WWRC)'s NICU. Physicians should refer the neonates for appropriate service according to a criteria set. Baseline analysis of one-month data revealed that 25%, 36%, 62% & 10%; of eligible neonates were not referred to 1) inpatient OT, 2) inpatient PT, 3) baby therapy & 4) neonatal neurodevelopmental clinic respectively. The objective is to reduce the number of eligible neonates not being referred to 4 available therapy services to 50% of the baseline data after 1 month of implementation of the study <h3>Design</h3> A quality improvement study. <h3>Setting</h3> 112 bed, level 4 NICU in WWRC, Doha, Qatar. <h3>Participants</h3> All the neonates admitted to the NICU from Dec. 6, 2020 - Jan 2, 2021 <h3>Interventions</h3> A Plan Do Study Act (PDSA) cycle was used to guide the interventions. 1st phase identified stakeholders' challenges for not referring the babies to appropriate services. Based on their feedback, the referral criteria were revised. In the 2nd phase, the revised criteria were implemented. Steps included - a) education to all stakeholders on the revised criteria & making it available all the time, b) daily triage & huddle to inform stakeholders of the needed referrals, & c) establishing communication pathways. <h3>Main Outcome Measures</h3> The number of eligible neonates referred to 4 available therapy services one-month post-implementation of the study <h3>Results</h3> Exceeding our targets, all eligible & 75%; of the eligible neonates for neonatal neurodevelopmental & baby therapy clinics respectively were referred. For inpatient OT & PT services, 22%; (targeted 12.5%) & 20%; (targeted 18%) of the eligible neonates were missed. <h3>Conclusions</h3> Within 1 month, we decreased the number of non-referrals to all 4 therapy services. Inpatient PT & OT referrals need more focus to achieve the target. Communication strategies with the physicians need revision to achieve all the targets. <h3>Author(s) Disclosures</h3> Nothing to disclose.