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Changing the Paradigm of Neonatal Care Shoo Lee, MBBS, FRCPC, PhD Paediatrician-in-Chief, Mount Sinai Hospital; Professor of Paediatrics, Obstetrics &

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Presentation on theme: "Changing the Paradigm of Neonatal Care Shoo Lee, MBBS, FRCPC, PhD Paediatrician-in-Chief, Mount Sinai Hospital; Professor of Paediatrics, Obstetrics &"— Presentation transcript:

1 Changing the Paradigm of Neonatal Care Shoo Lee, MBBS, FRCPC, PhD Paediatrician-in-Chief, Mount Sinai Hospital; Professor of Paediatrics, Obstetrics & Gynecology, and Public Health, University of Toronto; Scientific Director, Institute of Human Development, Child & Youth Health, Canadian Institutes of Health Research

2 Conflict of Interest None to declare

3 Victoria Vancouver New Westminster Edmonton Calgary Saskatoon Regina Winnipeg Montreal Ottawa Kingston Toronto London Hamilton Halifax St John’s Canadian Neonatal Network TM Quebec City Sherbrooke St John Moncton Fredericton Founded 1995 “Improve care through research”

4 Neonatal Outcomes Source: Congress of USA, Office of Tech Assessment, NTIS order #PB

5 EPIQ Conceptual Model Evidence FacilitationContext Organizational culture Individual behavior Barriers to change Leadership Change management Facilitation tools Published evidence Evidence reviews Clinical studies/trials Local data Best practice examples Practice guidelines Process Data Outcomes Data

6 THE EPIQ PROJECT - Transforming Care through Clinical & Implementation Research 30% decrease in severe eye disease causing blindness 30% decrease in hospital acquired infection 30% decrease in severe intestinal infection with high mortality 2 days average reduction in length of hospital stay $7-10M annual cost savings 30% decrease in severe eye disease causing blindness 30% decrease in hospital acquired infection 30% decrease in severe intestinal infection with high mortality 2 days average reduction in length of hospital stay $7-10M annual cost savings OUTCOMES (3 years) Reduce mortality, major morbidity and hospital length of stay in NICU Reduced Mortality, Morbidity and Hospital Length of Stay in Canadian Neonatal Intensive Care Units Pilot project in 12 sites outlining new practices for care National scale-up of the new practices, implemented in 30 hospitals and 17 universities across Canada Pilot project in 12 sites outlining new practices for care National scale-up of the new practices, implemented in 30 hospitals and 17 universities across CanadaPROJECT 6 Lee SK, Canadian Neonatal Network EPIQ Study Group, CMAJ DOI /cmaj OBJECTIVE

7 Family Integrated Care The Estonian Model Family Integrated Care

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9 Mothers health and wellbeing is considered essential to the baby’s wellbeing: - midwife - psychologist - physician Atmosphere of team support; Mother and baby are a unit, Nurse partners mother in the baby’s care Caring for Families

10 Estonia NICU Care Model Parents are Primary Care-Givers, not nurses Parents responsible for all care except IV, medication Parents participate in rounds, reports, charting Encourage developmental & kangaroo care Nurses are teachers and consultants Results = 30% reduction in NI 30% improvement in weight gain 20% reduction in LOS 50% reduction in nurse utilization improved parent/staff satisfaction

11 Current Family Centered Care Baby Nurse Doctor Therapist Family

12 Family Integrated Care NurseTherapist Parent Volunteer Doctor

13 Family Integrated Care Pilot Funded by AHFMR/MOHLTC Formative pilot at Mt Sinai 2011 Eligible patients = CPAP or less support Parents and Providers as planning co-leads Tremendous support from parent volunteers Planning, protocols, training modules, ethics, legal completed 40 families

14 Family Integrated Care Pilot Results Mount Sinai Hospital, Toronto 25% improvement in weight gain Decreased nosocomial infection - from 11.5% to zero Reduced critical incident reports - from 10% to zero Decreased parental stress CIHR funding for cluster randomized controlled trial at 16 hospitals NCE application for KT to all Level 2 NICUs

15 NEC Strategies The Japanese Way

16 NEC Incidence: Canada & Japan

17 Japan NEC Strategy Exclusive breast milk feeding for <28 weeks Aggressive feeding – full feeds in one week Avoid umbilical catheters Early use of PIC lines to reduce skin breaks Use antibiotics only if evidence of infection Transpyloric feeding catheters Probiotics Glycerin enema Minimal handling Encourage developmental & kangaroo care

18 Toronto Halifax Vancouver Winnipeg Montreal “Back to Basics – learn to respect Nature” Breast Milk for All Babies Calgary

19 Health System Implications Re-develop Facilities Reduced costsImproved outcomes Change in roles Fewer staff Re-train staff Parents Provide Care Re-organize Perinatal regionalization Appropriate use Of technology Developmental care Improved feeding Enhanced Follow-Up Milk Bank GentleR FAMILY INTEGRATED CARE

20 With acknowledgements: Canadian Neonatal Network Canadian Institutes of Health Research Michael Smith Foundation for Health Research Ontario Ministry of Health & Long Term Care Participating Institutions Thank You


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