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TRANSCRIPT
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Redesigning the Neonatal Intensive
Care Unit
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William Rhine, M.D. September 25, 2014
Neonatology – Early 1900 s
More sideshow than medicine
History of Neonatology – The Patrick Bouvier Kennedy Story
THEN: Born 8/7/1963 at 34 ½ weeks gestational age, 4 ½ lb. (2.11 kg.); died after 2 days
NOW: > 98% of such babies survive with normal lives
Modern Neonatal ICU
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NICUs Around the World – What Do You See and Don’t See? 1) What is similar?
a) Patients/families b) Medical staff c) Equipment d) Physical space
2) What is different? 3) What drives differences?
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NICUs Around the World
! China – Beijing, Hangzhou
! Lucile Packard Children’s Hospital Stanford
! Children’s Hospital Orange County
! Cook Children’s Hospital – Fort Worth, TX
! Family Integrated Care – Estonia/Sweden
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Bayi Children’s Hospital, Beijing
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Bayi Children’s Hospital, Beijing
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Bayi Children’s Hospital, Beijing
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Fudan Children’s Hospital, Shanghai
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Fudan Children’s Hospital, Shanghai
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Fudan Children’s Hospital, Shanghai
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Fudan Children’s Hospital, Shanghai
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Fudan Children’s Hospital, Shanghai
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Fudan Children’s Hospital, Shanghai
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Fudan Children’s Hospital, Shanghai
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Fudan Children’s Hospital, Shanghai
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Fudan Children’s Hospital, Shanghai
19 US Version
Fudan Children’s Hospital, Shanghai
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Fudan Children’s Hospital, Shanghai
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Children’s Hospital of Zhejiang University, Hangzhou
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Children’s Hospital of Zhejiang University, Hangzhou
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Children’s Hospital of Zhejiang University, Hangzhou
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Children’s Hospital of Zhejiang University, Hangzhou
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Children’s Hospital of Zhejiang University, Hangzhou
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Children’s Hospital of Zhejiang University, Hangzhou
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Children’s Hospital of Zhejiang University, Hangzhou
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Children’s Hospital of Zhejiang University, Hangzhou
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LPCH NICU – 1980’s Open bay style
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LPCH NICU – Bedside setup
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LPCH NICU – Supply Management
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LPCH NICU – Medical Team Rounds
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Children’s Hospital of Orange County
35 ENTRANCE SIGNAGE
Children’s Hospital of Orange County
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VISITOR SIGNAGE
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Children’s Hospital of Orange County
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Children’s Hospital of Orange County
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Children’s Hospital of Orange County
Small Baby Private Room
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Children’s Hospital of Orange County
Small Baby Private Room
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Children’s Hospital of Orange County
Small Baby Bay Rooms
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Children’s Hospital of Orange County
Small Baby Bay Rooms
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Children’s Hospital of Orange County
43 PATIENT INFO WHITEBOARD
Children’s Hospital of Orange County
44 INSPIRING MESSAGING
Children’s Hospital of Orange County
45 INTERMEDIATE (STEPDOWN) NICU
Children’s Hospital of Orange County
46 STAFF QUALITY IMPROVEMENT POSTER
Children’s Hospital of Orange County
47 STAFF QUALITY IMPROVEMENT POSTER
Children’s Hospital of Orange County
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NOISE REMINDER DEVICE
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Children’s Hospital of Orange County
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PARENT CHAIR FOR KANGAROO CARE
Children’s Hospital of Orange County
50 FAMILY STAY ROOM
Children’s Hospital of Orange County
51 FAMILY STAY ROOM
Cook Children’s Hospital – Ft. Worth
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Cook Children’s Hospital – Ft. Worth
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Cook Children’s Hospital – Ft. Worth
54 PARENT LOUNGE
PATIENT ROOM
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Cook Children’s Hospital – Ft. Worth
55 PATIENT ROOM
Cook Children’s Hospital – Ft. Worth
56 PATIENT ROOM
Cook Children’s Hospital – Ft. Worth
57 PATIENT ROOM
Cook Children’s Hospital – Ft. Worth
58 PARENT STORAGE SPACE AND BREASTMILK FRIDGE
Cook Children’s Hospital – Ft. Worth
59 BREASTMILK WARMING DEVICES
Cook Children’s Hospital – Ft. Worth
60 BEDSIDE MONITOR AND REMINDER NOTICE
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Cook Children’s Hospital – Ft. Worth
61 TWIN ROOM
Cook Children’s Hospital – Ft. Worth
62 TRASH ACCESS
INSIDE ROOM
Cook Children’s Hospital – Ft. Worth
63 NURSING STATION
Cook Children’s Hospital – Ft. Worth
64 PARENT LOUNGE
Cook Children’s Hospital – Ft. Worth
65 PARENT LOUNGE
Family Integrated Care
Examples from Estonia, Canada
and Sweden
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• Mother’s health and wellbeing is considered essential to the baby’s wellbeing:
• Atmosphere of team support;
• Mother and baby are a unit;
• Nurse partners mother in the baby’s care
Caring for Families Estonia NICU Care Model ! Parents are primary caregivers, not nurses ! Parents responsible for all care except IV, medications ! Parents participate in rounds, reports, charting ! Encourage developmental & kangaroo care ! Nurses are teachers and consultants ! Results = 30% reduction in nosocomial (hospital-
acquired) infection 30% improvement in weight gain 20% reduction in LOS 50% reduction in nurse utilization improved parent/staff satisfaction
Family Integrated Care Pilot Results Mount Sinai Hospital, Toronto
• 25% improvement in weight gain
• Decreased nosocomial infection - from 11.5% to zero
• Reduced critical incident reports - from 10% to zero
• Decreased parental stress
Family Integrated Care – Uppsala, Sweden
Family Integrated Care – Uppsala, Sweden Family Integrated Care – Uppsala, Sweden
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Family Integrated Care – Uppsala, Sweden The Future NICU at LPCH
Who and what influence NICU design?
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