Streamlining the Newborn Infant Physical Examination (NIPE) Process on the Maternity Ward to Improve Productivity

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Background & Problem:

This project aims to improve the NIPE process for infants on the Maternity Ward at Gloucester Royal Hospital. All infants receive a NIPE within 72 hours of birth, typically before discharge.

Due to workload, there is often a backlog NIPE’s, with 22% of infants consequently having discharge delayed. An audit identified the time to complete a NIPE varied from 13 – 82 minutes, with an average time of 34 minutes. Variation was attributed to interruptions and delays with 38% of NIPE’s interrupted at least once e.g. to respond to bleep (14%), attend a delivery / emergency (12%) or respond to midwifery concerns (28%). Also 56% of NIPE’s suffered at least one delay for other reasons, including misplaced notes (38%) and unavailability of mother or baby (22%).

We aimed to improve the process by reducing interruptions and delays, which would ultimately reduce the average time taken to complete the NIPE and reduce discharge delays.

SMART Aim:

1) Reduce average time taken to complete a NIPE by 30% in 4 months.

2) Reduce percentage of interruptions and delays to the NIPE process by 30% in 4 months.

3) Reduce percentage of discharges delayed as awaiting a NIPE by 30% in 4 months.

Method:

• Engagement of key stakeholders.
• Baseline audit detailing time taken to complete NIPE and delays or interruptions.
• Neonatal bleep to be help on NNU rather than Maternity Ward.
• Separation of NIPE and Review workload and timed slots.
• Prioritisation of infants according to readiness for discharge.
• Medical notes to be returned to slot.

Results:

All project aims were achieved.

1) The average time taken to complete the NIPE process reduced from 34 minutes to 17.2 minutes, a relative reduction of 50%.

2) The number of NIPE’s being interrupted or delayed at least once reduced from 76% to 20%, a relative reduction of 77%.

3) The number of discharges delayed because infant is awaiting a NIPE reduced from 22% to 8%, a relative reduction of 63%

Lessons Learnt:

Making process changes works best when all stakeholders are aware of the rationale.

Be prepared to provide evidence for the changes you want to make to key stakeholders.

Next steps:

To facilitate more midwives to be able to do NIPEs by providing assessment to those in training and participating in refresher conferences.

Potentially take improvements further by initiating a NIPE and neonatal in-reach clinic.