Faculty Collaboration Database

Variations among US hospitals in counseling practices regarding prematurely born infants. J Perinatol 2013 Jul;33(7):509-13

Date

01/26/2013

Pubmed ID

23348867

DOI

10.1038/jp.2012.172

Scopus ID

2-s2.0-84879694654 (requires institutional sign-in at Scopus site)   31 Citations

Abstract

OBJECTIVE: We studied several counselor-independent elements of prenatal counseling regarding prematurely born infants. Elements studied include: indications to offer counseling, clinical settings in which counseling is offered, personnel assigned to counsel, availability of tools to assist counseling and post-counseling documentation requirements.

METHOD: As the study aimed to explore system-based practices and not counselor-based practices, we surveyed Neonatal Intensive Care Unit medical directors.

RESULT: Responses were received from 352 hospitals (53%) in 47 states. Analysis was based on responses from the 337 hospitals that routinely counseled women anticipating a premature birth. In 299 (≈ 90%) hospitals, counseling was primarily performed by neonatal professionals. Premature labor was the most common indication to offer counseling; however, in 54 hospitals most counseling was offered before labor and based on maternal risk factors for preterm delivery. In nearly all (99.7%) hospitals information was provided verbally and face-to-face; a third of the hospitals also provided written information. For non-English-speaking Hispanic patients, 208 (62%) of the hospitals had certified hospital-based Spanish interpreters. Five (1%) hospitals provided specialized training to the designated prenatal counselors. The upper gestational age eligible for counseling at all 337 hospitals included 33 weeks; in 134 hospitals, gestational age of <23 weeks was not eligible for counseling.

CONCLUSION: Antenatal parental counseling for premature delivery is a widely practiced intervention with substantial system-based variability in execution. Interventions and strategies known to improve overall counseling effectiveness are not commonly utilized. We speculate that guidelines and tool-kits supported by Pediatric and Obstetric professional organizations may help improve system-based practices.

Author List

Mehrotra A, Lagatta J, Simpson P, Kim UO, Nugent M, Basir MA

Authors

Mir Abdul Basir MD Professor in the Pediatrics department at Medical College of Wisconsin
Joanne M. Lagatta MD Professor in the Pediatrics department at Medical College of Wisconsin
Pippa M. Simpson PhD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Counseling
Documentation
Female
Gestational Age
Health Care Surveys
Humans
Infant, Newborn
Infant, Premature
Intensive Care Units, Neonatal
Practice Patterns, Physicians'
United States