Implementing a Newborn Home Visit at Swedish FP Residency Rebecca McKindles, MD Lisa Rothlein, MD Swedish Family Medicine Residency Rocky Mountain Research Forum

Learning Objectives 1.Describe benefits of newborn home visits 2.Describe implementation process at a residency program 3.Describe obstacles of implementing home visits Rocky Mountain Research Forum

Newborn Home Visits: Benefits Trend towards lower rate of preventable child death for groups receiving home visits ◦Targeting first-time mothers, lower socioeconomic status, visits by RN through 2 years of life 1 Babies are less likely to use emergency care in the first 8 weeks of life 2 1. David L. Olds, et. al. Impact of Home Visiting by Nurses on Maternal and Child Mortality. JAMA Pediatr Sep;168(9): Yonemoto N, et. al. Schedules for Newborn Home Visits in the Early Postpartum Period. Evid Based Child Health Mar;9(1):5-99 Rocky Mountain Research Forum

Newborn Home Visits: Benefits Increased maternal satisfaction with care in the postnatal period Trend towards increased exclusive breastfeeding at 6 weeks for groups receiving newborn home visits. Yonemoto N, et. al. Schedules for Newborn Home Visits in the Early Postpartum Period. Evid Based Child Health Mar;9(1):5-99 Rocky Mountain Research Forum

Home Visits At A Residency Program 3 Pilot at the Department of Family Medicine at Brown University, Randomized to receive HV at 1 week and 1 month (n=9) versus standard in office visits (n=8) Results included a decreased number of sick visits through 6 months and decreased number of after-hours calls 3. Lakin et. al. Newborn well-child visits in the home setting: a pilot study in a family medicine residency. Fam Med Mar;47(3): Rocky Mountain Research Forum

Home Visits At A Residency Program 3 Higher perceived level of support by the mothers with regard to providers. Increased perceived level of connection from the resident perspective with their patients Increased confidence among the residents to provide anticipatory guidance and breastfeeding counseling in the home setting 3. Lakin et. al. Newborn well-child visits in the home setting: a pilot study in a family medicine residency. Fam Med Mar;47(3): Rocky Mountain Research Forum

QI Question Are newborns who have home visits more likely to have increased rates of two week weight check compliance, increased breast feeding compliance at 2 months of age, and a decreased number of emergency calls than newborns who receive routine, in office follow up? Rocky Mountain Research Forum

Scheduling a Home Visit: Process Ascertain interest in HV prior to admission for labor or as soon as possible with admission After delivery, call front desk to schedule visit on Monday or Thursday mornings, verify address Residents are scheduled out of NICU (1 st year) or Outpatient (2 nd year) pediatric rotations Visits are with the resident and either attending physician or physician’s assistant Rocky Mountain Research Forum

Supplies! Rocky Mountain Research Forum

Obstacles Resident and attending scheduling – not taking away from other activities Initially 1 day/week – did not have regular visits Remembering to discuss during OB visits Incorrect address - and phone number! Resulted in perceived no - show Home conditions – need to be creative! (exam table, lighting, accidents, equipment failure) Rocky Mountain Research Forum

Primary Objectives Improve 2 week weight check compliance Improve breastfeeding compliance Decrease emergency calls in first 2 months Rocky Mountain Research Forum

Methods Examine breastfeeding compliance at 2 months Measure 2 week weight check compliance Measure number of urgent telephone calls prior to 2 months of age Records pulled from EMR (eclinical works) Will be compared to newborns born to SFM during this same time period 1/2016-present who undergo office visits Rocky Mountain Research Forum

Results – so far… SFM office visits – 44 visits (Newborn weight checks) -2 week weight check compliance – 75% -Breast feeding compliance (2 months)– 50% -Avg # of emergency calls (2 months)– 0.4 Home visits – 9 visits -2 week weight check compliance – 89% -Breast feeding compliance (2 months) – 100% (most data still pending) -Avg # of emergency calls – 0.4 Rocky Mountain Research Forum

Case Reports – positives! Skin to Skin Convenience (we arrived in a snowstorm!) Comfort with provider (special bond) Really get to know patients Comfortable environment No time constraints Rocky Mountain Research Forum

Case Reports - negative Dirty environment Unsafe conditions Rocky Mountain Research Forum

Plans for the future 2 week weight check home visits Transcutaneous bilirubin Training in lactation consulting for residents Multidisciplinary approach for high risk patients (bring social worker on visit) Increased resources for mom – staple removal, mood check, incision check Measure maternal, resident satisfaction with survey Rocky Mountain Research Forum

Contact Information Lisa Rothlein – Becky McKindles – Rocky Mountain Research Forum

References David L. Olds, et. al. Impact of Home Visiting by Nurses on Maternal and Child Mortality. JAMA Pediatr Sep;168(9): Yonemoto N, et. al. Schedules for Newborn Home Visits in the Early Postpartum Period. Evid Based Child Health Mar;9(1):5-99 Lakin et. al. Newborn well-child visits in the home setting: a pilot study in a family medicine residency. Fam Med Mar;47(3): Rocky Mountain Research Forum