In the past, newborns in the neonatal intensive-care unit at Intermountain Healthcare’s Dixie Regional Medical Center in St. George, Utah, might be subjected to up to 78 tests or treatments before being discharged.
Interventions are not only painful for delicate newborns, they can also increase the chances of infection, which may result in extended hospital stays and increased costs. Studies have demonstrated that preterm babies are three times more likely to contract a healthcare-associated infection than full-term babies as a result of the invasive monitoring and procedures, which can take their toll on infants' weakened immune systems.
After reviewing these statistics, Dr. Erick Ridout, a neonatologist at Dixie’s NICU, and the unit’s nurse manager, Jeannette Cutner, decided to make changes. In 2008, they started tracking interventions on babies in the 40-bed unit in an effort to substantiate every test and procedure. Ridout believes that many tests are routine but often unjustified. In general, estimates suggest that $200 billion is spent in the US each year on healthcare procedures that have little value.
After consulting with the NICU’s 52 staff members, including nurses, nurse practitioners, respiratory therapists, dietitians and neonatologists, Ridout and Cutner decided to implement new practices. For example, blood taken from newborns is now withdrawn from the umbilical cord rather than the baby to reduce the number of pokes.
The changes have led to substantial drops in infection rates and cost savings for Dixie Regional. The average length of stay for preemies in the NICU has dropped by 21% from 72 days to 57 days. Also, the average number of blood draws has fallen from about 75 to fewer than 40. In the past 11 years, only one baby has had a central line-associated bloodstream infection, and the system has saved at least $2.8 million.
With NICU admissions growing nationally, the new practices could mean big savings across the healthcare industry. A 2015 study by Dartmouth researchers revealed that NICU admissions had increased by 23% in just five years, with most babies born preterm.
In an effort to reduce costs and enhance quality, Dixie Regional will use artificial intelligence to detect unnecessary treatments in the NICU because the staff has “eliminated most of the low-hanging fruit,” Ridout said. An electronic dashboard will track treatments and tests for every newborn in order to identify potentially avoidable treatments.