Rural Clinician Management of Complex Neonatal Patients
Hunter New England Area Health Service
Abstract
In Hunter New England’s Greater Newcastle Cluster HNE/NC there are 15,000 babies born each year, with 1100 admitted to the Neonatal Intensive Care Unit (NICU) at John Hunter Children’s Hospital.
These babies undergo complex care, and for those born extremely premature, transitioning back to the community with their ongoing complex needs requires skill, knowledge, communication and teamwork.
With the aim to train rural health professionals in the ongoing care of preterm infants with complex needs, eight multidisciplinary neonatal staff, skilled in the care of the complex issues pertaining to prematurity developed an outreach education program. The education delivered was interactive and based on adult educational principles.
Four geographically-spread sites across Hunter New England Health were selected, to attract staff from all health services, for the two-day program.
A before and after questionnaire has shown a substantial increase in participant’s knowledge and confidence in managing babies with complex issues. In addition, strong communication links have been developed with clinicians across the region.
A multidisciplinary educational program has delivered improved knowledge, confidence and understanding of the issues of complex ex-NICU patients in the Hunter New England Health Greater Newcastle Cluster.
Aim
To improve the competence and confidence of rural clinicians in the management of complex neonatal patients.
Nature of the Problem
Twenty five per cent of babies cared for in the NICU at John Hunter Children’s Hospital are referred from other hospitals within NSW. Of these babies, 75 per cent are from the Hunter New England region and 15 per cent from the North Coast region.
Transitioning these babies back to rural hospitals highlighted the gap in appropriate service availability, between metropolitan and rural hospitals.
Knowledge and confidence in caring for these babies in the community is variable outside the tertiary setting.
Extent of the Problem
Problem identification:
- Survey of neonatal resuscitation education in NSW & ACT in 2002
- Lack of rural education
- Task safety analysis on neonatal transports - JHCH 2005
- Courses run in metropolitan centres inaccessible to rural clinicians- solution- provide education in rural setting
- Communication
- Rural clinician demand for education with funding provided
In 2006/07, Investigator PC saw about 500 infants in multidisciplinary outpatient clinics at John Hunter Chrildren’s Hospital. During those clinics, it became apparent that infants returned with ongoing complex needs often required extensive input due to a lack of appropriate local services such as specialised paediatric allied health professionals.
Strategic Importance
This neonatal outreach education program was developed to meet the needs of complex neonatal infants transitioning home to their local hospital and community. This program relates to strategic directions documented in the Children’s, Young People and Families service plan 2007-2011 written to provide direction for children’s services in Hunter New England Health (2007). Specifically to meet the following strategy directions:
- Actively engaging health clinician and key Hunter New England Health partners in an integrated network
- Recruiting, developing and sustaining a skilled and self-reflective workforce to meet changing needs.
Planning and Implementing Solutions
A group of paediatric allied health and neonatal professionals brainstormed the issues to identify common ongoing problems, causes and then solutions to the problems.
The team met several times and identified the major problem as knowledge and confidence in caring for complex neonatal patients following discharge.
With the recognition there was an ongoing need for specialised education to be taken to the rural clinicians we formed a multi-disciplinary team to identify, develop, and deliver an appropriate education program across the Hunter New England’s Greater Newcastle Cluster HNE/NC region.
The team comprises a neonatologist, neonatal nurse, Physiotherapist, Occupational Therapist, Speech Pathologist, Dietician, Social Worker and a Lactation Consultant.
A successful grant application was made to the Northern Child Health Network resulting in $15,000 to provide funding for the project.
Four geographical sites spread across Hunter New England Health were selected for the two-day program to ensure staff from all health facilities across the area had the opportunity to attend the program. The first four workshops were held at Muswellbrook, Tamworth, Taree and Moree.
The content and advertising material for the workshops was developed by the team. Each program was advertised locally and registrations were coordinated by a local clinician. Each workshop was interactive and multi-disciplinary, with an equal number of participants from allied health professionals, midwifery, Child and Family Health Nurses (CFHN), and medical officers with a maximum of 40 participants for each workshop.
The educational material was developed on simple adult educational principles, and included small group teaching, video, role play, demonstrations, skills practice with some didactic presentations. All participants were provided with handouts of presentations, and a list of presenters with their contact details.
A business plan was developed to ensure all educators had accommodation, transport and incidental costs covered as well as a plan to replace equipment with natural degradation.
A pre and post confidence questionnaire was developed by the group to evaluate the impact of the program on the participant’s confidence in recognising and managing issues faced by infants and their families following discharge from the NICU.
Outcomes and Evaluation
Four two-day education workshops were held at Muswellbrook, Tamworth, Taree and Moree. A total of 174 health professionals have attended the program from a wide range of disciplines, comprising midwives (41 per cent), Child and Family Health Nurses (20 per cent), medical officers (5 per cent) and allied health professionals (30 per cent) – see Figure 1.
Participants in the workshops were asked to complete a pre-course and post-workshop confidence questionnaire. The return rate for the questionnaires was 72 per cent (125/174) for the pre questionnaire and 71 per cent (123/174) for the post questionnaire.
The questionnaire was divided into sections and participants were asked to complete the questions for all sessions that they intended to attend and those they did attend. The questionnaire's consisted of a five-point confidence scale and for ease of data analysis these have been categorised into two subgroups with confident / very confident combined and neutral/ not confident / very unconfident combined.
The average pre and post confidence for each session is demonstrated in the graphs below, with the number of questions included in each session identified (n= number of questions).
For each session the results demonstrate a substantial increase in the confidence of rural clinicians.
Sustaining Change
Following positive evaluations from initial workshops additional funding has been sourced from Northern Child Health Network to present additional workshops in Hunter New England Health (planned for JHH campus and Armidale), and two workshops in North Coast Health (planned for Coffs Harbour campus and Tweed Heads).
Since 2005, Neonatal Outreach education programs have been regularly presented by neonatal staff across Hunter New England Health and the North Coast. Evaluations from each program provide feedback and suggested topics to be covered in future workshops. Regular communication is maintained with clinicians in the rural areas who provide topics and possible venues for future education sessions and workshops.
Future Scope
Tertiary NICU units within NSW have more extensive expertise and staff than rural settings. Each NICU within their area health, including their referral area, could provide support for newborn infant care and the transitioning of infants to the community by providing education and acting as a resource. This model facilitates the development of networking and communication channels across the referral area.
To reduce the cost of financial and staff resources required by individual units for such a program there is the potential for education to be facilitated by a central body, for example NSW Perinatal Services Network utilising a roster of staff from all units.
References
- Forster, K., Craven, P., & Reid, S. 2006. Neonatal resuscitation educational experience of staff in NSW and ACT hospitals. Journal of Paediatrics and Child Health, 42(1-2):16-19.
Project Team
- Paul Craven, Staff Specialist,Neonatal Intensive Care Unit
- Denise Kinross, Neonatal Intensive Care
- Rosie Day, Senior Physiotherapist in Paediatrics
- Kylie Duncan, Paediatric Social Work
- Rachael Brent, Occupational Therapist
- Martine Ward, Paediatric Social Work
- Brodie Warren, Speech Pathologist
Contact
This project was entered in the 2008 NSW Health Awards, Build a Sustainable Health Workforce category.
