This study evaluates the use of a NICU clinical integration system (Dashboard and accessories) in improving the quality of care delivered, patient health outcomes, and parent and clinician satisfaction. Clinicians will be asked to follow their current standard of care practices with the aid of this technology. About half of participants will receive care in NICU rooms with the Dashboard installed while the other half will receive standard care without the Dashboard.
The current NICU environment can be stressful and overwhelming for parents of babies admitted and for clinicians caring for the babies. There is a wide range of monitors in a very clinical environment that does not take into account the comfort of neonates. The Dashboard works in parallel with EHR and systems of record, and provides a cohesive view of the patient's status and planned clinical workflow in a single location for both parents and staff. Accessories such as environmental sensors and cameras are used to ensure that the environment is comfortable and promotes optimal development of the baby. Caregivers can educate and coach parents to facilitate integrating them into their infant's care. The NICU Dashboard also supports a family view to facilitate education and assist the family in tracking core measures and developmental milestones.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
OTHER
Masking
NONE
The NICU Dashboard is displayed on a touch screen display mounted to the wall or on a rolling cart that will be placed near the bedside. The Dashboard will integrate information from various hospital/device sources in order to provide clinicians with one location to access and collectively interpret clinical findings and environmental factors. Parents will have their own view on the Dashboard that will allow them view their baby's progress, view educational materials, and have access to other resources at their fingertips.
Memorial Hospital of South Bend
South Bend, Indiana, United States
Rate of neonatal adverse events
Preventable adverse events (e.g. unplanned extubations, medication errors)
Time frame: Through study completion, an average of 1 year
Incidence rate of Chronic Lung Disease
Diagnosis
Time frame: Through study completion, an average of 1 year
Rate of Readmission
Number of readmissions (within 7 and 30 days) to a hospital over the number of total babies
Time frame: 7 days and 30 days post-hospital discharge
Baby growth velocity
Rate of weight gain
Time frame: From date of NICU admission until the date of NICU discharge, assessed daily up to 365 days
Percent of time noise levels are within range
Hours that noise levels are within range over total patient-time
Time frame: From date of NICU admission until the date of NICU discharge, assessed daily up to 365 days
NICU Length of Stay
Days spent in the NICU from admission to discharge
Time frame: From date of NICU admission until the date of NICU discharge, assessed up to 365 days
Baby to parent skin-to-skin time
Self-reported time parents are performing skin-to-skin (kangaroo care), averaged
Time frame: From date of NICU admission until the date of NICU discharge, assessed daily up to 365 days
Parental Stressor Scale:NICU (PSS:NICU)
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For NICU parents 26-item questionnaire broken down into three constructs (Parental Role Alterations, Sights and Sounds of the Unit, and Infant Behavior and Appearance) designed to measure parental perception of stressors arising from the physical and psychosocial environment of the neonatal intensive care unit. 1. = Not at all stressful (the experience did not cause you to feel upset, tense, or anxious) 2. = A little stressful 3. = Moderately stressful 4. = Very stressful 5. = Extremely stressful Total score will be calculated by summing each item score and averaged for the group. Each subscale will also be computed by summing the items within the subscale and averaging for each group. Higher scores represent worse outcomes
Time frame: Upon signing informed consent (baseline) and within 96 hours of discharge
Neonatal Index of Parent Satisfaction (NIPS)
For NICU parents 30-item questionnaire measuring parents' satisfaction with the care their newborn child receives while in a neonatal intensive care unit (NICU). 7-point Likert-scale (1) lowest satisfaction to (7) highest satisfaction. Sum item scores to calculate total score, with lower scores corresponding to worse outcomes.
Time frame: Within 96 hours of discharge
System Usability Scale (SUS)
For NICU parents and clinicians 10-item questionnaire with 2 constructs: usability and learnability 5-point Likert-scale (1) strongly disagree to (5) strongly agree The participant's scores for each question added together and then multiplied by 2.5 to convert the original scores of 0-40 to 0-100. Though the scores are 0-100, these are not percentages and should be considered only in terms of their percentile ranking. Based on research, a SUS score above a 68 would be considered above average and anything below 68 is below average, however the best way to interpret your results involves "normalizing" the scores to produce a percentile ranking.
Time frame: Six months after study initiation (mid-point) and 12 months after study initiation (completion)
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey
For NICU parents 7-item questionnaire assessing communication with doctors (4-items) and nurses (3-items). 4-point Likert-scale: Never, Sometimes, Usually, Always The number of "Always" ratings for each participant is summed then divided by the number of items. The mean is then taken, stratified by group. Higher scores represent better outcomes.
Time frame: Within 96 hours of discharge
Emotional Exhaustion Scale
For Clinicians only 4-item questionnaire about job-related frustrations. 4-point Likert-scale: (1) Disagree strongly to (5) Agree strongly. Item scores are summed and averaged by group. Higher scores represent worse outcomes.
Time frame: Baseline (before study initiation), six months after study initiation (mid-point) and 12 months after study initiation (completion)
Teamwork Perceptions Questionnaire (T-TPQ)
For Clinicians only 21-item questionnaire measuring 3 constructs: team function, mutual support, and communication 5 - Strongly Agree 4 - Agree 3 - Neutral 2 - Disagree 1 - Strongly A total score is calculated for each teamwork construct. Summing scores in this manner allows for more accurate statistical testing. High scores indicate better outcomes.
Time frame: Baseline (before study initiation), six months after study initiation (mid-point) and 12 months after study initiation (completion)
Frequency of Missed Care (MISSCARE)
For Clinicians only 35-item questionnaire assessing the frequency that elements of nursing care are missed by nursing staff on the unit. 1. \- Always missed 2. \- Frequently missed 3. \- Occasionally missed 4. \- Rarely missed 5. \- Never missed Scores will be averaged per item, and a total MISSCARE score will be computed per individual by averaging all items. Higher scores represent better outcomes.
Time frame: Baseline (before study initiation), six months after study initiation (mid-point) and 12 months after study initiation (completion)
NASA Task Load Index (NASA-TLX)
For Clinicians only 6-item survey that rates perceived workload in order to assess the current workload in the NICU. Increments of high, medium and low estimates for each point results in 21 gradations on the scales assessing mental demand, physical demand, temporal demand, performance, effort, and frustration. Averages for each subscale will be computed. Higher scores represent worse outcomes.
Time frame: Baseline (before study initiation), six months after study initiation (mid-point) and 12 months after study initiation (completion)
Percent of time light levels are within range
Hours that light (lux) levels are within range over total patient-time
Time frame: From date of NICU admission until the date of NICU discharge, assessed daily up to 365 days