P2D189: A QI Project to Improve Attendance Rates of Hypoxic-ischemic Encephalopathy (HIE) Infants at the NICU Developmental Follow-up Clinic

Purpose/Objectives: Infants with Hypoxic Ischemic Encephalopathy (HIE) at birth are at increased risk for brain injury and adverse neuro-developmental outcomes. Timely assessment of potential impairment can facilitate appropriate referral to physical, occupational and speech therapies, and to early intervention programs. Attendance at the post-discharge neurodevelopmental follow-up clinic can be as low as 55% resulting in many infants without the necessary assessment and referral for therapies.
Our SMART aim was to increase the follow up rate of infants with HIE to the NICU developmental follow up clinic from 55% to >90 % by July 1, 2023 using a three-step intervention bundle

Design/Methods: All infants with HIE who received therapeutic hypothermia are followed at the NICU neuro-developmental follow-up clinic. Infants with HIE born from July 1, 2022 to January 1, 2023 were included. Institutional review board approval was obtained. Baseline follow up rate was collected from January 1, 2020 to December 31, 2021. In July, 2022, this QI project implemented an intervention bundle using Plan-Do-Check-Act (PDCA) methodology to assess improvement in attendance rates. A multidisciplinary team including physicians, nurse practitioners, social workers, occupational therapists and appointment schedulers convened to assess the barriers for successful follow up. This intervention bundle suggested by the team included three steps: 1) Scheduling an appointment within 4 weeks following discharge, 2) Discussing with family/caregiver the importance of attending the appointment prior to discharge, 3) Calling the family/caregiver by phone one day prior to the appointment as a reminder as well as an electronic medical records (EMR) automated reminder. The PDCA cycles are ongoing. The outcome measure is the rate of attendance following the use of the intervention bundle.

Results: Twenty-four infants with HIE were included to calculate the baseline follow up rate. The baseline follow up rate was 55% for the first visit. In this ongoing project, ten patients have been followed and we have seen an improvement in the outcome measure of the first visit follow up rate from 55% to 100%. Potential barriers such as transportation issues, ready availability of outpatient slots for rescheduling and availability of telemedicine visits have been identified for the subsequent one and two year visits. The first PDCA cycle implemented in January 2023 will incorporate solutions to these barriers to improve attendance rates.

Conclusion/Discussion: The HIE specific intervention bundle will improve the follow up rate in the developmental clinic. Improved follow up rates will improve coordination with rehabilitation therapy services and thus improve the quality of care provided to these infants. Similar projects will help to improve follow up rate for other infants with high risk factors for neurodevelopmental delays like extreme prematurity and neonatal abstinence syndrome.