Arkansas Children’s Hospital Leads Nursery Alliance to Enhance Newborn Care, Combat Infant Mortality

Since 2016, the Arkansas Children’s Hospital (ACH) in Little Rock Nursery Alliance has been paying it forward to neonatal intensive care units (NICUs) and newborn nurseries around the state, sharing high-level expertise to improve the quality of newborn care and reduce infant mortality.    

ACH NICU neonatologists, nursing and other clinical staff share education and training with members of the alliance, creating a statewide network of care stretching beyond the walls of the hospital to the following health care entities:    

• CHI St. Vincent, Hot Springs 
• Conway Regional Health System, Conway  
• Jefferson Regional Medical Center, Pine Bluff   
• Saint Mary’s Regional Medical Center, Russellville   
• Saline Memorial Hospital, Benton  
• South Arkansas Regional Hospital, El Dorado

Other nursery alliance partners include Arkansas Children’s Care Network and the ACH Injury Prevention Center.    

Ashley Ross, M.D., chief of neonatology and co-medical director of the ACH NICU in Little Rock, serves as the alliance’s physician lead.  

While neonatal and perinatal collaboratives are common nationally, Dr. Ross said this alliance's focus on Level I and II NICU's is unique. This alliance centers on hospital-based solutions and community level activities, like home visitation programs, to improve infant outcomes.   

"Creating opportunities to improve and better coordinate care outside the walls of ACH is one of the best ways to improve outcomes for children in Arkansas. It can have a real impact on community health and helps standardize care by being part of the alliance. With improved confidence, care can truly be closer to home," Dr. Ross said.  

 

Changing the narrative    

According to 2022 Centers for Disease Control and Prevention (CDC) statistics, Arkansas ranked the third highest for infant mortality in the United States, with 7.67 infant deaths per 1,000 live births.  

To help combat this startling trend, ACH’s NICU, the only Level IV NICU in Arkansas, provides the following benefits to alliance members:   

• ACH neonatologists provide educational support, quality data review, implementation of best practices in collaboration with ACH and training as needed to help the babies at the member hospital receive the best care.   
• ACH nurses and other interdisciplinary care teams are available for consults, staff education and access to best practice standards of care to assist member hospital team members in caring for infants and at-risk newborns.   
• The alliance develops opportunities to improve outcomes and participation in ongoing research.   

In addition to Dr. Ross, three Arkansas Children’s neonatologists, a NICU nurse educator and several NICU hospitalists contribute their expertise to the alliance.   

How the alliance works

ACH and alliance members work to identify local improvement areas and increase training through ongoing gap analysis for newborn health.   

There are several ways the program strengthens education, including:   

• Interventions, which might include shadowing nurses, respiratory therapists or speech therapists, are given for providers to gain additional perspective and insight.    
• Simulation scenarios increase confidence and education around a particular topic.  
• Lunch and Learns (monthly or every other month) are developed based on feedback from sites and their perceived gaps in knowledge and are open to all providers at each hospital. 
• ImprovementU was modified for members to complete independently to give members further training in quality science.
• TeleNICU is implemented at three alliance-member sites, allowing for video consultation by an ACH neonatologist. Adding video enhances the ability to give timely and pertinent advice on newborn care remotely. ACH plans to expand capabilities to all alliance sites in the coming years.  
• The alliance hosts local nursing skills fairs and on-site observation days at ACH.  

ACH experts typically meet with each site at least twice yearly to evaluate needs. In-person simulation is targeted throughout the year. The annual ACH Nursery Alliance Summit has included executives and clinicians from alliance hospitals. 

Spreading knowledge through partnership  

ACH’s leadership of the alliance has led to several achievements in training and education for members.   

"Conway Regional needed additional training on surfactant administration. In conjunction with the ACH Simulation Center, we developed a scenario to train physicians, nurses and respiratory therapists as a team. The center and I spent a couple of days at Conway Regional training over 50 providers in surfactant administration," Dr. Ross said. "We helped implement a CPAP respiratory support program at CHI St. Vincent in Hot Springs, including a respiratory weaning protocol. We facilitated information sharing and the implementation process of using glucose gel to prevent hypoglycemia in at-risk newborns. The original work was at Hot Springs but shared across the alliance sites."   

The alliance also targeted training opportunities around video intubation, providing simulations in Conway and Russellville. The alliance is piloting telemedicine simulation at Saint Mary's Regional Medical Center in Russellville, where an ACH provider can help run a local simulation remotely.

Register to vote in the next U.S. News & World Report Best Children’s Hospitals survey.