Increasing Communication to Improve the Retro-Transfer Process in Neonatal Care: A Quality Improvement Project

The birth of an infant requiring hospitalization in a neonatal intensive care unit (NICU) is undoubtedly a stressful experience for parents. Due to the regionalization of neonatal care, most infants admitted to the NICU at The Hospital for Sick Children (SickKids) are acutely treated then subsequently retro-transferred to a lower-level NICU for convalescent care (McCormick, 1995). Literature shows that this transition is viewed by parents as anxiety provoking, with many parents emphasizing the need for more information regarding the environmental and practice differences between their current and prospective NICU’s (Hawthorne & Killen, 2006; McDonald Gibbins & Chapman, 1996). Parents express needing earlier and more detailed information on the timing and process of the transfer (Hawthorne & Killen, 2006; McDonald Gibbins & Chapman, 1996; VanManen, 2012).

To fulfill these needs, healthcare providers must work alongside families to understand their experiences and fill the gap in their understanding of transitions. Currently, the NICU at SickKids does not have the information necessary to prepare parents for their child’s transition from SickKids’ NICU to lower-level, community NICU’s. The overall aim of my fellowship is to obtain the necessary knowledge and expertise to develop a transitional information tool to be used to improve communication and provide open, goal directed information to parents regarding their child’s transfer from our NICU.

As a bedside nurse, this fellowship offers me the unique opportunity to combine two of my interests: quality improvement and family-centered care. This fellowship will also allow me to evolve as a leader in the NICU by gaining more experience in implementing evidence-based practice changes on my unit. My goal is to expand my learning while also developing a tool that can provide information to parents about their prospective NICU. By better informing parents, we as healthcare professionals, are empowering them and engaging them in their child’s care, which can have positive impacts by decreasing parental stress levels, decreasing reluctance to transfer, and accordingly decrease NICU length of stay (Hawthorne & Killen, 2006; McDonald Gibbins & Chapman, 1996; VanManen, 2012). This can also set a strong, positive foundation for future interactions with the healthcare system.