327 - Barriers To Forward & Back Transfers From a Quaternary-Care NICU to Local Community NICUs

Poster Number: 327
Publication Number: 327.1126

Background: Neonates and mothers are frequently transferred from a local community neonatal intensive care unit (NICU) to a quaternary-care NICU for specialized care. Once medically stable, it is often advantageous to transfer the neonate back to a community hospital closer to home. Back transfers improve parental satisfaction with patient care, cost-effectiveness of hospitalization, and bed utilization by hospitals. However, widespread implementation of successful transfers have been limited due to existing challenges with the process of authorizing a transfer.

Objective: To describe barriers preventing successful back transfers amongst all neonates admitted to our quaternary-care Newborn Center who were eligible for transfer back to community NICUs as part of an ongoing quality improvement project.

Design/Methods: We identified 49 neonates admitted to our NICU from July 2022 - March 2023 who attempted a back transfer during their admission (Figure 1). We conducted a retrospective chart review to determine the number of patients successfully transferred and identify barriers preventing any unsuccessful transfers.

Results: We found that 19/49 (39%) of patients were successfully transferred. In our cohort, 32/49 (65%) of patients had public insurance while 17/49 (35%) had private insurance; 14/32 (44%) of public payors were successfully transferred compared to 5/17 (29%) of private payors. Possible delays during the process were identified including: payor approval and errors made when obtaining authorization; issues with insurance enrollment; and accepting hospital at capacity (Figure 2). Key drivers for unsuccessful transfers included hospital, family, payor, and state policy areas (Figure 3). Possible solutions to these barriers were also identified.

Conclusion(s): Challenges exist to successful transfers. By implementing the proposed solutions to address these barriers, more transfers may be completed successfully, benefiting both patients’ families by improving their quality of care and hospital systems by enhancing resource allocation in NICUs.