In the third of our four-part series “Hot Topics in Neonatology” we talk with health care providers who are on the frontlines working to prevent adverse outcomes and improve the quality of care for the most vulnerable babies.
SEGMENT 1: Necrotizing enterocolitis (NEC) is the most common and serious intestinal disease among premature babies. It’s so dire that preventing it has become the life’s work of many who treat pre-term babies, including Dr. Sheila Gephart with the University of Arizona College of Nursing in Tucson. Dr. Gephart and her team have created an NEC prevention protocol bundle that is showing promising outcomes, and she’s using a telementoring tool called Project ECHO to “force multiply” implementation and training around the protocol bundle to make large-scale change easier to accomplish at NICU level.
SEGMENT 2: Continued quality improvement (QI) is a high priority for every health care system at every level of care — and our nation’s NICUs are no exception. When working with the smallest of babies in the most precarious of medical situations, the principles of high reliability, the reliance upon evidenced-based protocols and practices, the ability to sustain success and to learn from failures are absolute necessities.
Neonatologist Dr. Hannah Fischer is Director of Quality Improvement and Safety for the Division of Neonatal Medicine at Norton Children’s Hospital in Louisville, Kentucky sits down with us to discuss her philosophy of NICU QI, bringing QI to NICUs across her state, and the quality measures that are critical in the first 60 minutes of the life of of a premature newborn — the so-called “Golden Hour”.
Guests:
Sheila Gephart, PhD, RN, FAAN, Professor and Interim Chair, Division of Biobehavioral Health Sciences, University of Arizona, College of Nursing
Hannah Fischer, MD, Associate Professor, Division of Neonatology at the University of Louisville
Producer/Host: Carol Vassar
Explore the Full Series:
Part 1, Episode 50
The NICU View: Mom & Baby
Part 2, Episode 51
Fluid Dynamics: What’s New in Treating EPRA
Part 4, Episode 53
Babies in Crisis: Understanding Neonatal Abstinence
EPISODE 52 TRANSCRIPT
Carol Vassar, podcast host/producer:
Welcome to Well Beyond Medicine, the Nemours Children’s Health Podcast. Each week we’ll explore anything and everything related to the 80% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar, and now that you are here, let’s go.
MUSIC:
Well Beyond Medicine!
Carol Vassar, podcast host/producer:
Welcome to part three of a four-part series on hot topics in neonatology. Necrotizing enterocolitis, known as NEC, or N-E-C, is the most common and serious intestinal disease among premature babies. It’s so dire that preventing it has become the life’s work of many who treat preterm babies, including Dr. Sheila Gephart with the University of Arizona College of Nursing in Tucson. Dr. Gephart and her team have created an NEC prevention protocol bundle that is showing promising outcomes, and she’s using the telementoring tool Project ECHO to force multiply the implementation and training around the protocol bundle to make large-scale change easier to accomplish at the NICU level. We met up with Dr. Gephart at the recent hot Topics in neonatology conference in National Harper, Maryland and began our conversation with an overview of the life-threatening condition affecting mainly premature infants known as NEC.
Dr. Sheila Gephart, University of Arizona:
NEC is a disease that primarily affects premature infants, although babies that are born with congenital heart disease or other defects later in gestation are also at risk. And what it is it’s a terrible disease that affects the intestine. And when the baby becomes sick, it’s like an infection in the intestine that can lead to breakdown of the intestinal wall. So much so that that loss of integrity of the intestinal wall can lead to a rupture of the intestine and that whatever’s in the intestine then spills into the whole gut, and it’s not unexpected that they would end up having broad infections and could even die.
So it’s known as the chief abdominal emergency of prematurity. It’s the number one cause of emergency surgery in the NICU. And it’s really bad. You can imagine if you were to lose half of your gut as an adult, it would be devastating to you. But for a premature infant, when so much of their immune system lives in their gut, if they were to lose half of their gut or two-thirds of their gut, it leaves them very debilitated, and it impacts their long-term ability to absorb nutrients. So they often have long-term treatment with IVs and it also impacts their liver and their other organs. It’s very challenging for babies, but there’s hope.
Our evidence-based bundle is focused on the prevention and timely recognition of the disease. And it builds off of great work that’s been done across the world really in the prevention of NEC.
Carol Vassar, podcast host/producer:
And children who are diagnosed with NEC are little preterm babies. There’s a high mortality rate here, isn’t there?
Dr. Sheila Gephart, University of Arizona:
There’s a very high mortality rate. So, for babies who need surgery, it’s around 30%.
Carol Vassar, podcast host/producer:
That’s high.
Dr. Sheila Gephart, University of Arizona:
It is high. And if they’re very small babies that need surgery, it’s closer to 50 or 60%.
Carol Vassar, podcast host/producer:
Tell me more about this protocol, this bundle, as you referred to it. What’s entailed with that?
Dr. Sheila Gephart, University of Arizona:
So it’s really on the prevention side, and it’s focused on helping clinicians deliver the best care for every baby, every time, everywhere. And it’s kind of simple, really it’s promoting human milk, prioritize human milk, beginning with mom’s milk and colostrum for oral care if available. It also involves donor milk if mom’s milk is not available. Secondly, it includes the adoption of a standardized feeding guideline, and we actually don’t specify which feeding guideline a unit is to use. We just say you need to have one and to adopt it, and to deliver it consistently. Thirdly, it involves medication stewardship, so limiting excessive antibiotics and antacids. And then lastly, it involves a timely recognition approach using a risk score and some sort of communication process.
So for that part of it, we have a risk tool called GutCheckNEC that I developed with a team, and we recommend using that tool or one of the other tools like eNEC or neonates to help screen for risk for NEC and then to help nurses communicate with doctors and neonatal nurse practitioners using a standard approach when they’re concerned about NEC. And underlying the entire bundle is a very pervasive and thoughtful approach to engaging families all along the way because they really have so much to lose here, and they are so invested. They know their babies. They want to know what the risk factors are for complications. They want to know warning signs to watch out for. So, we have a whole suite of parent education tools that we’ve created as part of the NEC-Zero toolkit that’s designed to help engage families.
Carol Vassar, podcast host/producer:
You’ve covered all the bases, and you’ve had success with this protocol. Talk about that.
Dr. Sheila Gephart, University of Arizona:
So, the chief success we’ve had so far is just having units use the protocol. And in terms of the success of NEC bundles broadly, it’s very good. When NEC bundles are implemented, they reduce NEC rates by somewhere between 40 and 90% when they’re adopted consistently, and there’s good evidence for that. The NEC-Zero bundle has been downloaded a great number of times from our website, especially the GutCheckNEC score, which has been downloaded about 10,000 times when we last checked. So we don’t actually know for sure how much it’s been used. And so I think that’s important as just a limitation. I don’t want to overstate what we’ve been able to accomplish so far, but we’ve done some work doing outreach to NICUs, and we’ve helped facilitate seven NICUs to adopt the bundle and have created just a host of tools that anyone can use anywhere.
Carol Vassar, podcast host/producer:
It sounds like a bundle that you want to spread more widely, and I think that’s where Project ECHO might come in. Define what Project ECHO is. We’re turning the spotlight on that.
Dr. Sheila Gephart, University of Arizona:
Okay. Project ECHO is really fun to talk about. Project ECHO is a fascinating movement. It’s an international movement, and it involves a few key features. It can be described as telementoring, where you connect experts with local experts or local clinicians who are actually delivering care. And it helps to share expertise. Dr. Arora from University of New Mexico, he started Project ECHO, and he talks about it as democratizing knowledge, which means you don’t just hold knowledge in the ivory tower, but the point is to get it out to the people who need it and to help them through a process we call facilitation, but it’s helping people to implement something that may seem rather complex. He talks about it like you are teaching someone to drive a car. If you were to teach your child to drive a car, you wouldn’t just give them the owner’s manual or the driver’s manual and say, “Here you go.” Because, technically all of the instructions are in those two documents, but what they need is they need somebody to help them sit in the car with them to help them to understand, “Okay, turn right. Don’t do that. You’re stopping too close.” Giving all of those just-in-time redirections to help people learn how to do something complex.
So with Project ECHO, you basically combine telementoring experts, local clinicians. You have case-based learning, and you create this learning community among the participants. And so those are the features of it. The other point with Project ECHO is that using telehealth or telementoring to work with teams basically who participated in our project, you’re helping them to multiply their efforts, and you’re multiplying your efforts because as a nurse scientist at the University of Arizona in my office, I don’t have the reach that all these people in the NICUs have, and I don’t have the knowledge either. I don’t really know what they need to adapt an intervention that’s worked in Ohio to work in Nevada or in Texas or maybe an intervention that’s worked really well with people who are well-resourced. They need to adapt that intervention to work in their unit where they have to take care of more babies, or they don’t have access to certain things.
Carol Vassar, podcast host/producer:
So tell me how you are employing Project ECHO to improve the quality of care for preterm babies who might be in NICUs, wherever they may be, wherever they receive care. That’s really the whole genesis of all this. Talk about that.
Dr. Sheila Gephart, University of Arizona:
So actually, back in 2019, we did a pilot project where we took the NEC-Zero bundle, and we worked with seven NICUs at that time in the southwest, and we recruited local change champions, people in the units who they already had clout, they already had a reputation with their peers, and they worked with us to do this ECHO project, and it is really simple actually. They got teams together. We turned on the Zoom, and we were all on the session together synchronously at that time for 90 minutes. And at that point, the people in Nevada connected with the folks in Texas and in Arizona, and we were all together in that space. And so for about three months, we met every couple of weeks, and they got their teams together. For the first 90 minutes, we would do our part of it, which was a didactic presentation about some component of the bundle, the evidence tools to help implement it, and whatnot.
Then we had one of the units present a case and then they talked among themselves. They had questions like, for example, say they had a baby who developed NEC who had a MRSA infection, and actually, the mother had MRSA. The issue was that she stopped breastfeeding and stopped providing human milk because of this infection. And so there was a lot of complexity around that case because they had infection control involved as well as lactation and medicine and nursing. And it just reflected some of the complexity that people are dealing with boots on the ground every day, trying to do the best care they can for these babies. A similar case came up where there was a lot of judgment that came up around a mother who couldn’t provide enough human milk for her baby. And it was important for that to surface in the session because then there was opportunity for people as a learning community in other places to kind of check that and to identify, “Hey, it sounds like you have some bias against this mother’s inability to provide enough human milk, what else was going on?”
And so it was really a very respectful space, and it was up to us to kind of keep that bar high in terms of respect. But we were able to really dig deeper to some of the social factors that were underlying her challenge in providing human milk for her baby. And to identify quality improvement targets that they could consider in their unit to help make that more possible for her or for the next mom who came through. So it happened that there was transportation issues, there were kids at home, there were twins. Mom didn’t start pumping until later. There were about six different quality improvement targets that were identified in two sentences of a case presentation that was brought up. And as we talked about it, this is what happens in the learning community part, which is so powerful. It wasn’t just for their benefit. It was for the benefit of the six other NICUs that were represented on the call that day. And so they also were able to reflect, “Wow, we’re not doing any social risk screening in our unit. Maybe we should consider doing some of that to help our moms, to help our families.” It was really humbling actually to see that unfold.
Carol Vassar, podcast host/producer:
It really is about the moms and the families and the babies.
Dr. Sheila Gephart, University of Arizona:
And the families. Yeah. And the families.
Carol Vassar, podcast host/producer:
Is this scalable? What’s the future of this project?
Dr. Sheila Gephart, University of Arizona:
That’s the best thing about Project ECHO is that it’s so scalable. It is so scalable, and that’s the vision for it. We’re in the process of trying to get some funding to expand Project ECHO. My heart is really to support teams that are in under-resourced units to participate because they may not have the resources to join other, more costly quality improvement learning communities. I think that there’s definitely a need to target disparities, healthcare disparities in which we definitely have in NICU and also with necrotizing enterocolitis. So it’s pretty scalable because it’s limited by your willingness of an internal facilitator to step up. It’s limited by the support of the organization that the NICU resides in to participate, but it’s free.
Carol Vassar, podcast host/producer:
That’s a good price.
Dr. Sheila Gephart, University of Arizona:
Yeah.
Carol Vassar, podcast host/producer:
To save lives, free is very good.
Dr. Sheila Gephart, University of Arizona:
Yeah. It’s free. And we’ve talked about some sort of a business model to make it less free, but that’s really not my interest. And Project ECHO internationally is free. So it would be very odd for us to charge for it and probably not appropriate with the idea that if you think about Project ECHO being about democratizing knowledge, it’s sharing knowledge, it’s open sharing of knowledge, but there’s a time factor. And so, for a NICU to participate, they have to make the time and quality improvement takes time.
Carol Vassar, podcast host/producer:
Dr. Sheila Gephart is an Associate Professor at the University of Arizona College of Nursing in Tucson.
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Carol Vassar, podcast host/producer:
Continuous quality improvement is a high priority for every healthcare system at every level of care. And our nation’s NICUs are no exception. When working with the smallest of babies in the most precarious of medical situations, the principles of high reliability, the reliance upon evidence-based protocols and practices, the ability to sustain success and to learn from failures are absolutely necessary. Neonatologist Dr. Hannah Fischer is director of quality improvement and safety for the division of Neonatal Medicine at Norton Children’s Hospital in Louisville, Kentucky. At our hot topics in neonatology meetup, she sat down with us to discuss her philosophy of NICU quality improvement, bringing QI to NICUs across her state, and the quality measures that are critical in the first 60 minutes of the life of a premature newborn, the so-called Golden Hour. Here’s Dr. Hannah Fisher.
Dr. Hannah Fischer, Norton Children’s Hospital, Louisville:
So I see quality improvement as functioning on the continuum of research to bringing what we learn from research to the bedside, to the patients that we take care of. And it becomes vitally important then because it’s that last piece of the puzzle of actually improving care from everything that we have learned.
Carol Vassar, podcast host/producer:
And it’s not just exclusive to neonatology or to this form of medicine. Quality improvement is all over medicine. It really is a key piece to keeping people safe and keeping them healthy. Talk about how essential it is to the work you do as an MD, and particularly in the area of neonatology.
Dr. Hannah Fischer, Norton Children’s Hospital, Louisville:
Yes. I think that quality improvement is an essential piece for every person that touches the healthcare of a child, whether they’re a baby, older children, or adults too. And it really is, I think, that key piece of taking what we’ve learned from research and making it so that the patients actually feel that improvement, it improves their outcomes, whether that’s health outcomes, patient satisfaction, outcomes, financial outcomes, all of that goes into the value of care that we provide for our patients and their families.
Carol Vassar, podcast host/producer:
What are some of the common pitfalls and quality improvement? I know washing your hands is number one on everyone’s list for quality improvement. What are some of the pitfalls, and how can they be overcome?
Dr. Hannah Fischer, Norton Children’s Hospital, Louisville:
Yes. So, improving care at the bedside is challenging. You’re faced with complex systems and human behavior that you’re trying to change. So you’re pulling from these different pieces to actually improve an outcome. And I think that the common pitfalls really fall into a couple of different buckets. So, one big bucket is performing QI in a methodological manner. So, following the process that we know is important to doing each of those steps well. So, doing things like testing small and scaling up, understanding what you’re measuring, and having a good measure and a way to collect that data to represent it. And probably most importantly, how you put things in place to implement the changes that you make. And that means making them a permanent part of what we do. And sustaining those successes and outcomes. It’s also very challenging to put together a high-functioning team, and there’s lots of work being done to understand how teams work together to improve outcomes. And there’s always that piece of change management, how you help people change their behavior and the choices that they make. Because you can put in place the best processes, the best systems, but really it comes down to the choices that we make at the bedside. And so it’s important to influence that as well.
Carol Vassar, podcast host/producer:
An important part of quality improvement is the process that you talk about, the protocols that surround quality, evidence-based protocols. Talk about how important it is to have redundant systems and make certain that people implement the protocols in a very particular manner.
Dr. Hannah Fischer, Norton Children’s Hospital, Louisville:
Yes,. And that gets at, I think, the principles of high reliability. And we often talk about that in a safety capacity, but those same principles can be applied in quality improvement. And so having deference to expertise, having strong systems in place to give feedback and help people do the processes that you’re putting into place, because really the goal is for healthcare, whatever the process is, to be reliable and have people doing the thing that they intend to do every time and providing that high quality of healthcare with every touchpoint.
Carol Vassar, podcast host/producer:
Let’s talk about that premature child just been born. There is a 60-minute period from the time they’re born to, well, their first hour of life to really make sure that the treatment provided to them is lifesaving and is as high quality as possible. What quality measures are critical in that so-called Golden Hour?
Dr. Hannah Fischer, Norton Children’s Hospital, Louisville:
Well, I think as we build evidence for practices in the delivery room, that becomes the core of what we should focus on and quality improvement in that first hour. And so today at the conference, we heard a lot of talk about delivery room practices, in particular, delayed cord clamping. So finding out best practices for implementing that goes a long way for improving outcomes for our babies and ensuring things like our mothers have good prenatal care and that they have antenatal steroids that we know decrease things like intraventricular hemorrhage and NEC and mortality. And I think a key piece of that is understanding who isn’t getting those interventions that we know are best practice and making sure that we’re equitable and providing those. And it starts in the delivery room. That’s where you set yourself and your babies and your families up for success. And so it’s finding those key pieces that improve outcomes and making sure that it’s happening from the beginning.
Carol Vassar, podcast host/producer:
Are there some populations where the outcomes are not as good as they could be and quality improvement could be brought to bear?
Dr. Hannah Fischer, Norton Children’s Hospital, Louisville:
Yes. I think that we have to be mindful of the context in which our families are delivering babies. And so what hospital are they going to? And taking into factors like access to care and making sure that these evidence-based strategies aren’t just implemented in a high-functioning level four unit but that they’re spread all across where people are delivering and level two units, level three units. And even if you’re high risk, those units should have the same abilities that any other unit would have to provide those evidence-based interventions and set these families up for success.
Carol Vassar, podcast host/producer:
What are some of the barriers you’re facing when it comes to quality improvement in the NICU specifically?
Dr. Hannah Fischer, Norton Children’s Hospital, Louisville:
I think there are a lot of barriers that have really been highlighted over the last few years since the COVID pandemic. Along with many other groups, we have been faced with high rates of turnover and staffing shortages. And this makes it really hard in quality improvement because you are hoping to have a cohort of people that have worked well together and understand your culture and know what your processes are and can execute those. And when you have turnover, especially at such a rate that we’ve seen over the last few years, it really challenges that culture. And you oftentimes have to go back to the beginning and redo work that you’ve already done to make sure that you’re doing the things that you say that you should be doing. And so I think that’s been a huge challenge over the last couple of years.
Carol Vassar, podcast host/producer:
How do you build a culture that is high on quality, high on safety, and low on mistakes?
Dr. Hannah Fischer, Norton Children’s Hospital, Louisville:
Yeah. And I think that also goes back to those principles of high reliability, but also very importantly is your team and how you use your team members. I think that engaging different types of people as stakeholders in the project and understanding their perspective and using their expertise, not just having them on the team, but really making them team members and having them contribute all of their experience and knowledge, is very important. And that helps to build that culture. And also, they’re often the ones that are performing the work at the bedside, so they become your champions at the bedside, which is very important.
Carol Vassar, podcast host/producer:
And speaking of champions at the bedside, let’s talk about families. Let’s talk about parents in the NICU. Do they play a role in quality improvement and safety?
Dr. Hannah Fischer, Norton Children’s Hospital, Louisville:
Well, they’re probably our biggest stakeholder in the outcomes of the work that we do. So it’s very vital that we include them, and I think that we’ve proven through many of the quality collaboratives and work that’s been done that families can be integrated into this work. And I heard about a really amazing tool in one of our talks yesterday. It’s a tool that teaches family partners and quality about QI methodology so that they can have the tools they need to understand what you need from them to be a partner in this work.
Carol Vassar, podcast host/producer:
And what do you need from families? They’re in a high stress situation, they have just had a child unexpectedly early. How can they help with the QI process?
Dr. Hannah Fischer, Norton Children’s Hospital, Louisville:
Yes, I think that finding the right time to engage families is important, and that might be different for different families. So I think having that relationship and being able to talk to them about the work that we’re doing and when they would like to engage in that is really important. Having a family advocacy group that can be your connection to some of these families is a really great way to help to interact with them. We need family experience and for them to shine light on what the interventions that we’re trying, what does that mean for a family member? And what balancing measure are we not seeing here? As a physician, I don’t always see the barriers for families and what the things that we’re asking them to do, how that influences their life and what they’re bringing to the table.
Carol Vassar, podcast host/producer:
Let me ask this. We touched on culture in the NICU. How does the culture not only of the NICU, but of the hospital or the healthcare system impact quality improvement?
Dr. Hannah Fischer, Norton Children’s Hospital, Louisville:
Yes. I think that that culture seeps down to every single person that’s part of that organization. It also impacts us in the support that’s provided for quality improvement to be successful. So, the infrastructure needs. To do this well, you have needs for data collection and analysis. You need project support. You need buy-in from leadership stakeholders to support the work that you’re doing long-term and making sure that those interventions are supported and that people’s job descriptions reflect the work that we’re asking them to do. And so I think when you have an organization that’s committed to a culture of improvement, they understand those things, and they support them from the beginning.
Carol Vassar, podcast host/producer:
Let me ask you, you are a neonatologist. Do you still practice?
Dr. Hannah Fischer, Norton Children’s Hospital, Louisville:
I do, yes.
Carol Vassar, podcast host/producer:
Do you have an example of how quality improvement has impacted the life of a newborn or a prematurely born child?
Dr. Hannah Fischer, Norton Children’s Hospital, Louisville:
I do. Our center has recently embarked on a journey to improve neurodevelopmental outcomes in our infants and joined the All Care is Brain Care Collaborative through the Vermont Oxford Network. And the piece of the project that we chose to focus on was time to first hold. So, we have a lot of barriers in our unit for parents to hold their premature infants. We have parents that deliver all across Kentucky and the babies are brought to us. So there’s a disconnect there. These babies are being technologically supported. And so there’s just been a culture in our unit that these infants have been too sick to hold. And we have been working very hard as a team to change that culture and put things into practice so that parents can be involved in their child’s care from the moment they get into the NICU. And part of that is holding them early on.
And so we had a family who benefited from this work. This mom was able to hold her child in the first day of life, and that was really powerful for that family. And they had a tragedy in their family. And that mom did not survive the postpartum period. And this was the only time that this family was able to be a family, have a picture, have that time together holding their child. And I think that has really spoken to our team about the importance of the work that we’re doing. This was a tragedy that won’t affect all of our families, but having that mindset that this moment, even early on, is one of the most important moments to this family, I think, has really driven our work and given us the why behind why we’re making these changes. So when we go to nurses and our RTs and our teams and say, “Hey, I know this child is on a ventilator and has lines and tubes and things that make it really hard to hold, but this is why we want to do it.” Everybody buys into that culture and is able to make that change happen.
Carol Vassar, podcast host/producer:
It’s a bit bittersweet, but it still has positive benefits and positive vibes to it. Thank you for sharing that. What other projects are you working on in the area of quality improvement?
Dr. Hannah Fischer, Norton Children’s Hospital, Louisville:
Yeah, so we just completed a project to improve safe handoffs at the bedside around the time of surgery. And so we saw that our infants were coming back from surgery, and there it was a very chaotic environment, lots of things going on to get them settled back into the NICU. Our surgeons were coming in and out. Our anesthesiologists were coming in and out of the room and sharing information with the physicians but not necessarily with the nurses who were caring for the baby. And so, we worked really hard to define a strong quality measure around what a safe surgical handoff was. And so, our team defined that as all people were present for the handoff, the environment was conducive to a handoff. So it was quiet. There weren’t interruptions unrelated to urgent patient care. And lastly, that a standard handoff tool was used.
And so we really changed the culture around what a handoff can look like and created a shared mental model for that. And so we showed that when we approached handoffs in this way, we were able to decrease handoff-related care failures and improved communication and had a lot of fun doing it. We partnered with our anesthesia and surgical teams and their results were really remarkable.
Carol Vassar, podcast host/producer:
You talked earlier about how you seem to be the central hub for the state of Kentucky for NICU care, high-level, really, really medically complex children. Talk about the levels of NICU across the state of Kentucky and, generally speaking, across medicine. I am not sure our listeners know a lot about that. I know I don’t.
Dr. Hannah Fischer, Norton Children’s Hospital, Louisville:
Yes. And so we have delivery hospitals throughout Kentucky, and some of those are in rural areas. Some are in more urban areas. Many of them have nurseries, or actually, all of them would have nurseries. Many of them have NICUs. And so NICU levels vary by the complexity of the babies that they’re allowed to care for. There’s level one, level two, level three, and level four units. The level four units, there are two of them in Kentucky, and that’s for the most technologically complex infants. Those requiring consultants and surgeries and such. Level three units can still take care of very medically complex children, but they’re in hospitals that don’t have the surgical support. they are typically in kind of the larger cities, although we do have some representation in more rural areas.
But level two NICUs, excuse me, are really those NICUs that are throughout the state, and they admit babies and are able to care for many of the infants that are delivered in their area and keep them with their moms, and they transfer in babies to the higher level NICUs that need higher levels of care. But it’s really important for us as a level four unit to partner with those level two units to provide our expertise, our support and help make sure that they have good processes in place, guidelines for management, and especially when things are getting more complex, that we’re there to support them in that transfer process.
Carol Vassar, podcast host/producer:
Neonatologist Dr. Hannah Fischer is the Director of Quality Improvement and Safety for the Division of Neonatal Medicine at Norton Children’s Hospital in Louisville, Kentucky.
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Well Beyond Medicine
Carol Vassar, podcast host/producer:
Many thanks to today’s guests, Dr. Sheila Gephart and Dr. Hannah Fisher, for stepping up to our mics at the recent Hot Topics in Neonatology conference. And many thanks to you for listening.
What’s hot in Neonatology from where you sit? Leave us a voicemail at nemourswellbeyond.org. That’s nemourswellbeyond.org, where you’ll also find our previous episodes, subscribe to the podcast and leave a review.
Our production team for this episode includes Che Parker, Susan Masucci, Cheryl Munn, and Yari Payne. Our series Hot Topics in Neonatology concludes next time as we explore the detection and treatment of a growing problem stemming from the nation’s opioid crisis, neonatal abstinence syndrome. I’m Carol Vassar, and until next time, remember, we can change children’s health for good well beyond medicine.
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Well Beyond Medicine
