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9/29/14 1 Redesigning the Neonatal Intensive Care Unit 1 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 4 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? 5 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 6

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Page 1: Redesigning the s Neonatal Intensive Care Unit › ... › Redesigning-NICU-slides.pdf · 2014-09-30 · 9/29/14 1 Redesigning the Neonatal Intensive Care Unit 1 William Rhine, M.D

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Redesigning the Neonatal Intensive

Care Unit

1

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

4

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?

5

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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