Main PageMethodologyResultsDiscussion
The implementation of the ESC protocol in our hospital resulted in statistically significant reduction in length of stay and use of morphine. We attribute these findings to the emphasis on families at the center of care and non-pharmacologic interventions as first line treatment. By empowering families to provide treatment through non-pharmacologic therapeutic measures, most of our patients were provided adequate comfort and care through the peak of withdrawal without pharmacologic intervention. Decisions to utilize morphine as a treatment were made through shared decision making between the physicians, bedside nurses, and families, which reinforced the health care team model and kept families involved in a therapeutic framework. Additionally, the ESC protocol significantly decreased the length of time spent in the NICU. In traditional open-bay NICUs, this difference better preserves parent-baby bonding time, allows for more education and skills to be taught, and empowers families to be co-managing their baby’s treatment. By orienting parents as the center of the care team and as the primary treatment for their baby, it helps maintain the parent/baby dyad and provides skills for caring for a withdrawing baby beyond the hospitalization period.
These results do not support our hypothesis for breastfeeding time in the hospital, however at baseline our breastfeeding rates are high. We are encouraged that time spent in the Level 2 _NICU did not adversely affect breastfeeding rates. The rate of readmission was not statistically significant different between the groups; however, these rates were overall low with only 1 patient in each group requiring readmission.
Given reduction in LOS and decreased intervention, we extrapolated the ESC protocol reduced total cost of admission. Reduction in cost is mutually beneficial for hospitals as well as families facing the financial burden of prolonged hospitalization.
Overall, our data supports implementing the ESC protocol in a community hospital and demonstrates a meaningful impact for both community and hospital interests.
References
- Center for Behavioral Health Statistics and Quality (CBHSQ). 2017 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2018.
- Neonatal Abstinence Syndrome Births: Trends in the United States, 2008-2019. Healthcare Cost and Utilization Project. ONLINE. January 17, 2020. Agency for Healthcare Research and Quality. Available: www.hcup-us.ahrq.gov/reports.jsp.
- Dodds, D., Koch, K., Buitrago-Mogollon, T., & Horstmann, S. (2019). Successful implementation of the eat sleep console model of care for infants with NAS in a community hospital. Hospital Pediatrics, 9(8), 632-63.
- Blount, T., Painter, A., Freeman, E., Grossman, M., & Sutton, A. G. (2019). Reduction in length of stay and morphine use for NAS with the “eat, sleep, console” method. Hospital Pediatrics, 9(8), 615-623.
- Grossman MR, Lipshaw MJ, Osborn RR, Berkwitt AK. A Novel Approach to Assessing Infants With Neonatal Abstinence Syndrome. Hospital pediatrics. 2018;8(1):1-6. doi:10.1542/hpeds.2017-0128.
- Achilles, J. S., & Castaneda-Lovato, J. (2019). A quality improvement initiative to improve the care of infants born exposed to opioids by implementing the eat, sleep, console assessment tool. Hospital Pediatrics, 9(8), 624-631.
- Wachman, E. M., Houghton, M., Melvin, P., Isley, B. C., Murzycki, J., Singh, R., … & Gupta, M. (2020). A quality improvement initiative to implement the eat, sleep, console neonatal opioid withdrawal syndrome care tool in Massachusetts’ PNQIN collaborative. Journal of Perinatology, 40(10), 1560-1569.
- Miller, P. A., Willier, T., & Cleveland, L. (2021). Baby STRENGTH: Eat, Sleep, Console for Infants With Neonatal Abstinence Syndrome. Advances in Neonatal Care, 21(2), 99-106.