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Abstract
Aims Term admissions contribute a significant burden with respect to neonatal unit care and maternal-infant separation. Thus, there has been a recent NHS England focus on reducing avoidable term admissions1. Here we describe a single centre, tertiary neonatal unit experience, on the impact of participation in a Commissioning for Quality and Innovation framework (CQUIN) aiming to determine the causes of, and reduce avoidable term admissions.
Methods The term admissions CQUIN involved a critical, multidisciplinary review of all term admissions, to determine whether there were avoidable antenatal, perinatal or postnatal factors. Data was collected from the beginning of the CQUIN initiative in August 2015 until March 2016. The total term admission rates (number of term admissions/number of live births), avoidable admissions (avoidable neonatal admissions/total live births) and cause of admission was determined. Catagorical data was grouped into four two monthly periods (periods 1 to 4) and trends compared with Pearsons Chi-squared test.
Results There were 4354 live births during the study period and 127 term admissions to the neonatal unit. Of these, 100% were reviewed in line with CQUIN guidance and 56 (44%) were deemed avoidable. Following introduction of the CQUIN review process, the percentage of avoidable admissions declined from2.2% to 0.64% (Figure 1; p<0.05).
Percentage of avoidable term admissions
Term admission rates ranged from 3.3% to 2.1% across the CQUIN period (NS). The proportion of avoidable term admissions defined by cause is shown for the four study periods in Figure 2.
As the study progressed, the proportion of neonatal admissions from hypoglycaemia and jaundice decreased, those from asphyxia increased, and those from respiratory distress and infection were unchanged (Figure 2).
Causes of avoidable admissions
Conclusions Our data demonstrate that implementation of the term admissions CQUIN reduced avoidable term admissions. This has been facilitated through learning from review of cases and multidisciplinary “buy in” to change initiatives (such as implementation of use of 40% dextrose gel to reduce hypoglycaemia and BAPM NEWTT).