Improving NICU Rounds: Changing the Culture of a 25-Year Traditional Practice

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The BC Women’s Neonatal Intensive Care Unit (NICU) team cares for 1,700 fragile babies each year in its 60-bed, four-room unit. In November 2017, the unit will move its operations to 70 single rooms at the new Teck Acute Care Centre on the BC Children’s and Women’s Campus, eliminating the separation of mother and baby which has been demonstrated to improve health outcomes for both. The new design will require significantly redesigning areas of teamwork and communication, including how patient rounds have been conducted for the past 25 years.

In preparation for this change, the NICU has done extensive work to design an integrated family-centred model of care which includes a core care team comprised of the family, bedside nurse, bedside respiratory therapist, and the physician, supported by additional care service providers. This core team is one way that the NICU ensures families are at the centre of care. Another way they have improved the care they provide is through the redesign of patient rounds.

NICU patient rounds are an important way that care teams collaborate to review patients, share information pertinent to specific roles and care tasks to create daily goals for patient care. The goals are to maintain clinical stability and patient safety and chart a path towards discharge for each patient. Because of the redesign of the unit, as well as the nearly three-hour duration of rounds, the NICU team knew it had to redevelop its model. Its goal was to reduce the total time of rounds, and to improve family and staff satisfaction.

The specific objectives were to reduce the median duration of rounds, which was 225 minutes, by 25% and to improve staff and family satisfaction with rounds. After an implementation and trial period to test satisfaction and efficiency of changes, and weekly team meetings to gather feedback and suggestions, the NICU team implemented the following changes:

• Introduced a new situational awareness huddle between the neonatologists and clinical nurse leaders at the start of the day to identify the unstable babies that need an early round (unstable new admissions or babies that have deteriorated overnight).
• Introduced a rounds preparation period from 0900 – 0945 that detailed rounds preparation activities.
• Introduced a definitive rounds time from 0945 – 1145.
• Introduced a model for structured patient reporting to highlight variances/concerns.
• Reinforced contingency planning for unstable patients.

By outlining clear start times and schedules for rounds activities, the team was able to reliably include parents and families who want to be present. Structured patient reporting, developed with parent feedback, helps parents prepare to participate in rounds and articulate their concerns and goals for their babies. Since implementing the changes, the median duration of rounds has been sustained at about 125 minutes, a decrease of 44%.

As the NICU team prepares to move to its new unit, this improved method of rounds will facilitate high-quality, patient-centred support for the fragile babies under its care. The team hopes that other NICUs will consider their model of care and rounds methods a way of integrating family-centred care into all daily processes.