P3.O290: Development of routine caregiver experience assessment across 10-unit neonatal network: an equity-focused program

Background: The Black-White infant mortality disparity has historically been attributed to disparities in rates of prematurity and sleep related deaths. Within the neonatal intensive care unit (NICU), our clinical practice and educational efforts place significant importance on prematurity and safe sleep. However, since neither of these events directly occur within the NIUC, historically they have been perceived as less directly responsible for the observed tragic disparities. However, as neonatology is more regularly evaluating care and outcomes within and across units by race, there is evidence of disparities in care, clinical outcomes, safety events and family experiences. Traditional healthcare experience assessment tools are utilized retrospectively post encounter, such as with Press Ganey and Consumer Assessment of Healthcare Providers and Systems (CAHPS). These assessments leave the neonatal intense care unit (NICU) without intervenable feedback during a family’s long-term, single encounter experience. Furthermore, validated NICU caregiver surveys lack equity-focused questions.

Methods: Our multidisciplinary team created a program to assess NICU caregiver experience regularly throughout NICU admission at our 10-unit sites within our neonatal network as standard of care.

Results: Our team utilized the EMPATHIC-30 (EMpowerment of PArents in THe Intensive Care) questionnaire, validated for US NICUs. We added questions on family language preference, demographics and added a modified Expanded Everyday Discrimination Scale (EEDS), as well as survey feedback. The survey uses smart logic to minimize survey burden, while allowing a family’s journey to be tracked longitudinally across unit transfers, throughout admission. The survey and deployment plan were vetted through the NICU family advisory council. The survey underwent translation into our network’s top five non-English languages. It will be electronically administered via RedCap and widely advertised within the unit and on social media platforms. We are exploring integration within MyChart to reach families unable to be present at bedside. We are developing mechanisms to appropriately disseminate positive and constructive feedback to individuals, unit staff and managers, and the neonatal network health equity team to assess individual and systemic successes and failures.

Conclusion: We successfully and collaboratively created an equity-focused NICU caregiver experience survey for routine assessment of individual and systemic failures in delivering equitable care experiences to all families across our large neonatal network. Future work is needed after the survey’s deployment to ensure there are no unintended disparities created with roll-out and to ensure that data generated is utilized for improvements.