Multidisciplinary Team Working to Standardise Neurodevelopmental Follow-Up
A multidisciplinary approach to using QI methodology to improve the delivery, uptake and recording of two-year developmental assessments.
Our neurodevelopmental outpatient service has undergone redesign with reference to recently published NICE Guideline (NG 72) ‘Developmental Follow up of Children and Young People Born Preterm’ in August 2017 and Scottish Government neonatal care strategic plans in ‘The Best Start: Five-year Plan for Maternity and Neonatal Care’ in January 2017.
Causes of the Problem
Prior to the 2017 publications from NICE and the Scottish Government, we did not use a standardised assessment at two years corrected age and did not regularly report two-year outcome data.
Project Aim Statement
To use QI methodology to improve the delivery, uptake and recording of our two-year developmental assessments.
The project team, comprised of professionals from neonatology, physiotherapy, speech and language therapy and neonatal liaison, met quarterly to review and refine our plan. In addition, we held a national meeting with neurodevelopmental teams from across Scotland to share knowledge and experience within varied clinic settings.
PDSA Cycles / Solution(s) Tested
Our improvement project is summarised in the driver diagram (Figure 1).
Figure 1: Driver diagram, neurodevelopmental follow-up improvement project.
We have increased the number of two-year outcomes reported to NNAP, with over 94% of children in 2018 with health data entered (Table 1). Through collaborative working with neonatal units across Scotland we achieved high rates of follow-up reporting for children who had been discharged home from our neonatal unit that we had previously considered ‘responsibility of another unit’.
The Parent Report of Children’s Abilities Revised (PARCA-R) questionnaire and Schedule of Growing Skills II was introduced to our clinic during the 2018 data collection year which accounts for those children with incomplete assessments (12 and 6 children had been discharged prior to the introduction of SOGS and PARCA-R respectively). Since its introduction, 100% of families attending RHC clinic at two years corrected, have completed a PARCA-R questionnaire.
Table 1: NNAP follow-up and completion of standardised 2-year assessment rates.
How This Improvement Will Be Sustained
We have established a safe, equitable, efficient and cost-effective service that offers families a one stop clinic, delivered by a skilled multidisciplinary team.
Hear from a family who attended our clinic:
Challenges and Learnings
Top tips for implementation:
- Establish a core group of invested multidisciplinary professionals to deliver neurodevelopmental follow-up for your unit.
- Engage with families to provide feedback on and improve your neurodevelopmental follow-up service.
- Collaborate with other units in your network to achieve consistently high follow-up rates.
- Review your data throughout the year. If it is not what you anticipated, look more closely at the quality and accuracy of data input.
Suggestions For Further Implementation
We will continue to aim to empower parents, recognising they play an integral role in their child achieving their developmental potential.
Project Lead: Dr Louise Leven, Consultant Neonatologist, Alison Grant, Physiotherapy Service Lead, Sara Russell, Speech and Language Therapy Clinical Lead
Organisation: Royal Hospital for Children, Glasgow
Published: February 2020