Critical Path Network: Neonatal home program saves money, helps babies
July 1, 2002 4 minutes read
Critical Path Network: Neonatal home program saves money, helps babies
NICU-experienced nurses manage babies’ care
By sending prematurely born babies home an average of 3.5 weeks earlier than the average preemie, Carolinas Medical Center’s nursery staff and home care agency was able to save more than $3.3 million in the first 18 months of a neonatal home management program.
"In addition to the shortened length of stay and cost savings, we discovered that the babies gain an average of 32 g to 37 g per day as compared to premature babies in the hospital who gain an average of 20 g per day," says Martha J. Whitecotton, RN, MSN, vice president and chief nursing executive of Carolinas Medical Center in Charlotte, NC.
The program was implemented in 1998 after a two-year period of development, Whitecotton says. "We needed to reduce the length of stay in our neonatal intensive-care unit [NICU] in order to handle the number of babies we get, and we also learned through research that babies do better in the home," she says.
The long period of development was needed for several reasons, not least of which was changing a long-term practice of defining when the babies were ready to go home. "To go home, a premature baby has always needed to be able to maintain a stable body temperature in an open crib and eat and gain weight," Whitecotton says.
Evaluations made on case-by-case basis
However, the NICU nurses typically didn’t even put a baby in an open crib until he or she weighed 4 lbs., she explains.
Now, the practice is to evaluate each baby on an individual basis, and if the baby is stable in the isolette and has no other condition that precludes being in an open crib, he or she is moved, even if the baby weighs as little as 3 or 3.5 lbs., Whitecotton says.
"By weaning the babies from the isolette earlier, we are able to consider more babies for the home care program," she adds.
"We see the babies within 24 hours of their discharge to home, then call the parents every day for the first week," says Barbara Samartino, RN, a field nurse for the neonatal nurse management program. "The average number of visits is two per week for two weeks," she adds.
At the beginning of the program, eight visits were planned, then dropped to an average of five to seven and now the number of visits averages four, Samartino says.
The neonatal nurses also are instrumental in identifying babies that qualify for the program. In addition to making sure the baby can maintain body temperature, eat, and gain weight, the nurses look for motivated parents who are able to learn and are willing to accept responsibility for the baby’s care, Samartino says.
Hiring the right nurses was a challenge for the home health agency, says Dianne Wingate, RN, BSN, assistant vice president of Carolinas Home Care.
In addition to having experience with preemies, Wingate says she looked for nurses with excellent communication skills, good assessment skills, and the ability to make sound judgments on their own in the home care environment.
Intensive training prepares staff
After choosing the nurses for the neonatal home management program, the home health staff provided an intensive education in regulations, paperwork, Medicare and Medicaid coverage issues, safety, and information on community resources, Wingate says.
The neonatal nurses also accompanied home health staff on home visits and experienced home health nurses accompanied the neonatal nurses on the first several visits until everyone was comfortable, she adds.
"I definitely had to handle things I never encountered in the NICU," Samartino says. Upon arrival at one home, she discovered that the baby was ice-cold even though it was a warm July day and there was no air conditioning in the apartment.
"The teen-age mother could not drive, and her mother was at work and couldn’t be reached," she says.
The baby and mother needed transportation to the clinic but did not require an ambulance, and Samartino knew that she could not assume the risk of taking the baby in her car. "I called the clinic, explained the situation, and the clinic nurse sent a cab," she adds.
Everyone involved in the Carolinas Medical Neonatal Home Management Program agrees that the secret to success is the close collaboration between hospital and home health personnel. Wingate, however, adds one more piece of advice: "Don’t try to utilize existing home health nurses in this program. This is such a different population for home health that you must tap into the clinical expertise of the NICU to ensure the safety of these babies and good outcomes for everyone."
[For more information about Carolinas Medical’s Neonatal Home Management Program, contact:
• Dianne Wingate, RN, BSN, Assistant Vice President, Carolinas Home Care, P.O. Box 32861, Charlotte, NC 28232. Telephone: (704) 561-8500.]
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