Transitioning medically complex infants home: lessons learned from quality improvement efforts

ObjectiveDecrease: 1) time from tracheostomy or gastrostomy tube placement to discharge home, and 2) avoidable readmissions within 7 days post-discharge, for medically complex infants.Study designFive neonatology units and representatives from Medicaid and Managed Care Organizations participated. Measures included length of stay (LOS) from surgery to discharge, readmissions, and time from surgery to identifying home nursing. We used statistical process control (SPC) methods and bivariate tests for post-hoc before-after comparisons.ResultAmong 421 infants, no avoidable readmissions occurred in the final 25 months. LOS and all-cause readmissions were unchanged (SPC). LOS changes were variable, ranging from -39.5 days (tracheostomy and ventilator) to +30.8 days (tracheostomy without ventilator) and not significant. Median time to identify home nursing was 70.1 days (range 2-428).ConclusionAlthough lack of skilled home nursing precluded improving transitions from NICU to home in medically complex infants, all avoidable readmissions were eliminated for 25 months.