PremPath: Improving the optimisation and stabilisation of the preterm infant

Introduction to the project

Prematurity is a major cause of mortality in children under five and is associated with significant morbidity in surviving infants alongside considerable healthcare, social and education costs. A number of evidence-based interventions (place of birth, antenatal steroids, antenatal magnesium sulphate, intrapartum antibiotics, cord management, normothermia and maternal breast milk) have been shown to reduce the risk of neonatal death and associated preterm morbidities, and are intended to be implemented as a seven-element care pathway. However, audit data show variable uptake of this pathway with considerable differences between units and regional networks. This qualitative ethnographic project was commissioned to examine how the pathway is working in practice.

Aims of the study:

• To explore how multiple clinical teams work together to make decisions about the optimisation and stabilisation of preterm infants
• To explore the experiences of staff delivering the pathway, and parents and families receiving care.

Key findings

• Regional communities of practice help implement the optimisation pathway through significant relational effort.
• Data is crucial for improvement, but different systems and processes, and lack of trust in the data can impede improvement efforts; staff can feel unfairly judged by the data.
• Effective coordination across locations and professions is vital, yet gaps in this organising work can harm parents’ well-being.
• The place of birth policy creates logistical and financial burdens for families, as well as emotional cost.
• Threatened preterm labour and neonatal admission imposes emotional, financial, spatial and relational barriers, making shared decision making and parental involvement in care challenging.

Team

Nicola Mackintosh, Julie Roberts, Josie Anderson, Natalie Armstrong, Elaine Boyle, Penny McParland, Tom Padden, Carolyn Tarrant

Funding

This study/project is funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme (NIHR204242) and supported by the NIHR Greater Manchester Patient Safety Research Collaboration (GM PSRC). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care

Project outputs

Key Policy Recommendations:

Supporting improvements in care for preterm babies

Press Release:

Neonatal care recommendations for preterm babies could help save lives

Voices for Safety Podcast:

Patient Safety from the Start: Caring for Pre-Term Babies

Research summary:

PremPath: Improving the optimisation and stabilisation of the preterm infant