Transitions from neonatal intensive care unit to ambulatory care: description and evaluation of the proactive risk assessment process

Abstract

Objective: Over 20,000 US neonates annually make the potentially risky transition from the neonatal intensive care unit (NICU) to the care of primary care physicians whom they have never met. The authors describe the use of Health Care Failure Modes and Effects Analysis (HFMEA) to proactively assess the risks of this transition, and present a qualitative evaluation of the HFMEA process.

Methods: The HFMEA team, led by a patient safety specialist, included neonatologists, general paediatricians, nurses, a social worker and a parent of a premature infant. The authors conducted a facilitated debriefing session with the team, interviews of key informants, and a content analysis of documentation generated throughout the project.

Results: The authors identified 40 high-risk failure modes and 75 associated high-risk causes. Clear thematic categories included poor communication among care providers in the hospital, between care providers and parents/care givers, or between the hospital-based and ambulatory care providers, as well as a lack of knowledge and skills among community-based providers to care for fragile infants. Evaluation of the HFMEA process revealed a high level of involvement, with over 250 h of professional time devoted to the process, agreement that the interaction itself was valuable and concerns about the limitations of the HFMEA method in capturing the complexity of the transition from NICU to ambulatory care.

Conclusion: While HFMEA holds promise for improving the safety of care transitions, the full effort required to realise the potential benefit requires additional evaluation to confirm its value over less intensive means of achieving safer care transitions.