A new study shows the positive impact of private rooms and other transformations at the Sunnybrook NICU
For the first weeks of her life, Liliana LaFace was so tiny her father's wedding ring fit over her wrist like a bracelet.
Weighing only 630 grams at birth, Liliana's chances of survival improved exponentially through every minute of care she received at Sunnybrook. She is one of hundreds of prematurely born babies whom Sunnybrook doctors and nurses have shepherded to health each year at a world-class neonatal intensive care unit (NICU) that was recently transformed so that each family can have its own room. The hospital moved the NICU from Women's College Hospital to a newly constructed perinatal centre at Sunnybrook in September 2010.
The overall effect of providing families with private rooms has been positive for everyone, according to Jo Watson, a
Sunnybrook administrator who co-authored a study on the outcome of the move to private rooms and away from an open bay-style care model. Over a 12-month period, the impact of the change on babies, their parents and the staff supporting both was tracked.
"We've discovered something here that leaves babies healthier, leaves parents healthier, costs the system less money and improves staff satisfaction, safety and quality of care," she says. "Other centres can learn from this."
Liliana overcame the health challenges that follow when birth precedes the full development of lungs and a heart. She was a healthy 21-month-old who was keeping her parents very busy last December when her mother, Daniela, went into labour at 26 weeks with Liliana's sister Samantha.
"The thought that Samantha would come early was in my head. People kept reassuring me, but when the same stomach pain started, I knew what to expect," she says.
The birth was less fraught than Liliana's, but was still enormously stressful. Whereas Liliana had been cared for in an open bay-style room, with Samantha, the LaFace family benefited from the advantages of a private room.
"It was huge for us to be able to have privacy. I could bond in whatever way I wanted to. It was just me in my room, just like it would be at home," says Daniela. "We're very happy to be here. It's like having family watch her."
Moving the NICU to a specially designed space that affords each family a private room where they can work with and oversee their child's care has reduced some of the stress and anxiety known to plague the parents of preemies.
In considering the experience of 85 families, the majority of parents reported feeling more comfortable spending time with their baby. They were better able to understand their infant's signals and as a result became more confident feeding and comforting them.
Staff noted improved job satisfaction: Concentrating was easier, noise levels more manageable and overall communication and productivity improved.
The study also revealed a significant reduction in hospital-acquired infections and in medical errors. At the same time, the private room care model decreased the cost per patient per day from $1,500 to $1,100.
The benefits of private rooms stand in relief to the realities of open bay-style units typically found in NICUs throughout North America, where up to 12 babies are cared for in a large room. While each baby and the equipment needed for their care are allotted ample space, the amounts of noise and light the baby is exposed to cannot be regulated.
In open bay-style units, some families long for privacy – their stress amplified by easy exposure to the germs from surrounding people and the changes in health of nearby babies. The constant buzz and hum of equipment is known to wear down staff who are already managing the pressure of visually monitoring a number of babies despite the array of technological tools now available to do so.
The new private rooms at the Sunnybrook NICU provide a modest bed for parents who stay overnight. There is also room for a second cot. An entrance corridor for family members is separate from that which staff use. Each private room opens into a central space out of which staff work. Whiteboards are posted in each room to help facilitate easy communication between parents, nurses and doctors.
Sunnybrook's success with private rooms can also be attributed to the contributions of a parent co-ordinator, Kate Robson, who is herself the mother of preemies. Robson has been instrumental in mitigating parent stress and anxiety. In addition to building a rapport with each family within the NICU, she encourages participation in programmed group activities, including educational and holiday events.
Sunnybrook's NICU move was planned for many years. It resulted from extensive and careful research, as well as close consultation with staff, families and design experts.
Alongside Watson, study co-authors Marion De Land, Sharyn Gibbins, Elizabeth MacMillan York and Kate Robson hope that other facilities will benefit from their experience designing, moving to and working within the private room care model. Through their study, they aim to demonstrate that "research is an arena where Sunnybrook is building capacity in transforming the future of health care," Watson says.
"When you're caring for sick preemies, you have an obligation to do things right."
This content was produced by The Globe and Mail's advertising department, in consultation with Sunnybrook. The Globe's editorial department was not involved in its creation.