Practice Environments

​The capacities and services of the practice and the NICU(s) served should be evaluated with respect to community need and the delivery base to be covered. Factors relevant to this analysis include overall growth and demographics of the community, the number of needed and existing NICU beds in the area served (including those covered by competing practices), and stability of relationships between the hospital and the population served.​

If the practice receives patients from maternal or infant referrals from outlying hospitals, programs of outreach education for regional physicians, including outcomes analysis for quality improvement, should be explored. In addition to the physician communications with doctors at referring hospitals, staff personnel from the NICU may participate in peer review activities involving mothers and/or infants sent in for care. Hospitals with NICUs receiving outborn babies should include support for peer review and outreach education.​

The NICU Community

The NICU itself is a community of physicians, nurses, students, other health professionals, clerical staff, housekeeping, maintenance personnel, volunteers, and families and patients. Since form follows function, it is helpful to assess the relationship between the structure and layout of the NICU and the approach to patients' environments. The overall environment of the NICU involves the nursing administrative structure and its relationship to the physicians.

Parents and Families

Families are an integral part of the NICU community, not visitors. The environment for families is most reflected by the attitudes of the professional team and of the entire spectrum of staff working in the NICU, from physicians to hospital maintenance.

• Developmentally-supportive environment. Support for families requires space to accommodate their needs and policies supporting their involvement. Although there are debates over the specific requisites of developmentally supportive environments, there is no question that attention to the environmental impacts on the developing infant and on the family are important concerns of the modern NICU.

• Communications. Excellent family communication contributes to effective discharge planning, parental competence at care giving after discharge, parental satisfaction, informed decision-making, and risk management. These communications may be facilitated if the cultural diversity of the care giving staff reflects that of the patient population served. Units should have plans for addressing specific needs dictated by language, cultural practices, and religious or ethnic preferences. Use of social media for communication with families is being introduced in many settings.

• Policies. Hospital and NICU policies should enhance the communication and support needs of families. If the families are from a variety of ethnic, national, or cultural backgrounds, are there sufficient interpreters to assure accurate communication, appropriate environments to assure privacy, and comprehensive in-service educational programs and related resources on culturally-competent health care? Topics of these policies should include parental and family-member access to the nursery, kangaroo care and other care-giving by parents, access to charts and records, lactation counseling and support, preparation for discharge, care of the family of the terminally ill infant, grief counseling, and disclosure of errors and mistakes.

 Relationship with Other Services

Other nearby NICUs may be competitors or collaborators. Understanding the relationship to the other NICU units and staffs can be helpful, especially with respect to relief in times of high census and potential for educational interchange.

Collaboratives and Quality Improvement

Although not an environment defined by physical proximity, many practices function within one or more data-sharing collaboratives. From these environments dedicated to quality improvement, practices may incorporate protocols, use standard order-sets or forms, and participate in specific quality improvement activities. Sites which are parts of very large practice groups, such as those within Pediatrix Medical Group, can create and maintain a large database within the practice and also participate in other collaboratives. Data review, analysis, and quality improvement are essential components of practice and comprise activities essential to the quality improvement activity required for part 4 in the American Board of Pediatrics Program in Maintenance of Certification (MOC). Most modern practices have incorporated means to determine the position of their outcomes when compared to comparable practices. Explore how each practice you evaluate does its quality improvement and how these activities support MOC.

Helpful Questions to Evaluate Environments of the NICU

Demographics

• What delivery population is served by the NICU?
• What portions of those deliveries are in-born versus out-born?
• How many deliveries occur after maternal high-risk referral?
• Is the population stable, growing, or shrinking?
• Is the population sufficient to provide the unit with adequate numbers of intensive care cases?

NICU Environment

Capacity

• Is the NICU's capacity and services appropriate for the community's needs? ◦Are there competing services?
• ◦Plans for expansion? ​
• What support services are available? ◦Are available services consistent with needs?
• ​Which require waiting for scheduled consultant availability or transfer to another facility?

Nursing

• What is the structure of the nursing staff within the unit?
• If Nurse Practitioners work in the unit, by whom are they employed and how are they evaluated?
• How does the nursing administration interact with the physicians?
• How are policies and procedures proposed, implemented and evaluated?

Allied Health Professionals

(Clinical Pharmacist, Social Worker, Occupational or Physical Therapist, Respiratory Therapist, others)

• ​​What are the availability and timeliness of ancillary services?

NICU Design

Family-centered Care

Quality Improvement Collaborative Activity

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