SHM Converge Scientific Abstract ePoster Gallery-Nows the Time to Change: A Quality Improvement Initiative to Increase Inpatient Evaluations and Outpatient Referrals for Infants With Neonatal Opioid Withdrawal Syndrome

Nows the Time to Change: A Quality Improvement Initiative to Increase Inpatient Evaluations and Outpatient Referrals for Infants With Neonatal Opioid Withdrawal Syndrome

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This single-center quality improvement project focused on infants with Neonatal Opioid Withdrawal Syndrome (NOWS), a growing population at risk for adverse psychosocial and neurodevelopmental outcomes. Because recommended follow-up for these infants often includes physical therapy, occupational therapy, speech therapy, developmental pediatrics, early intervention, home health, and ophthalmology, the team aimed to improve both inpatient consultations and outpatient referrals.<br /><br />The project used retrospective chart review starting in July 2023 and excluded infants born before 34 weeks’ gestation or with congenital conditions. Three interventions were introduced: a NOWS inpatient order set in June 2024, a discharge flowsheet in April 2025, and a family education guide in January 2026.<br /><br />After implementation of the order set, inpatient consults increased substantially: PT/OT consults rose from 38% to 94%, and speech consults rose from 57% to 94%. After the discharge flowsheet was introduced, some outpatient referrals increased, including home health referrals from 33% to 39% and ophthalmology referrals from 22% to 39%. However, referrals to Early Intervention fell from 50% to 33%, and referrals to the Early Development Clinic fell from 28% to 17%.<br /><br />The authors conclude that structured tools such as order sets and discharge checklists can improve access to important neurodevelopmental services for infants with NOWS. They note that the discharge flowsheet had mixed results and may require additional staff education and reinforcement to improve use. They also plan to investigate why some referral rates decreased after implementation.

Asset Subtitle

Kofi A. Asare

Meta Tag

Author List Alessandra Dutra, Eliza Holland, Kofi A. Asare

Category Research

Concept Opioid Withdrawal

Concept Quality Improvement

Concept Outpatient Follow-up

Concept Inpatient Evaluation

Concept Neurodevelopmental Outcome

Distinguished Non-Finalist

Presenter Organization University of Virginia School of Medicine

Presenting Author Kofi A. Asare

Track Quality Improvement

Keywords

Neonatal Opioid Withdrawal Syndrome

NOWS

quality improvement

inpatient consultations

outpatient referrals

developmental services

physical therapy

speech therapy

discharge flowsheet

early intervention

Opioid Withdrawal

Quality Improvement

Outpatient Follow-up

Inpatient Evaluation

Neurodevelopmental Outcome