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Implementing team-based newborn well care: Perspectives of nurses and physicians

Published:April 07, 2022DOI:https://doi.org/10.1016/j.pedn.2022.03.013

      Highlights

      • Pediatric clinicians' experiences with primary care redesign implementation have not been well described.
      • In this pilot, teamwork improvements helped mitigate unpredictability in newborn needs and arrival times.
      • RNs and physicians valued teamwork but were concered that sharing visit taks could compromise patient relationships.
      • Resolving ambivalence about task sharing between RNs and physicians may support dissemination of redesign efforts.

      Abstract

      Purpose

      Pediatric primary care redesign includes changes to clinical teams and clinical workflows. This study described the perspectives of pediatric clinicians on their experience with redesign.

      Design and methods

      This qualitative study explored clinician perspectives on a newborn care redesign pilot at a pediatric primary care site. Newborn Hallway (NBH), implemented in 2019, clustered morning newborn visits with a single physician, increased RN staffing, and provided newborn-specific training for RNs. NBH also revised visit documentation templates to promote communication between RNs and physicians and shared completion of history taking and education. We conducted semi-structured qualitative interviews with clinicians. The interview guide was developed using the Consolidated Framework for Implementation Research. Interviews were recorded and transcribed, and coded using an integrated approach.

      Results

      We interviewed 17 staff (8 physicians, 8 RNs, 1 nurse practitioner) from 3/2020 to 1/2021. Clinicians reported that NBH implementation was facilitated by widespread agreement on baseline challenges to newborn care, and interest in optimizing roles for RNs. Clinicians believed NBH facilitated teamwork, which mitigated unpredictability in newborn needs and arrival times, and improved staff satisfaction. Perceived barriers to NBH included staffing constraints and ambivalence about whether sharing tasks with RNs would negatively influence patient relationships and continuity.

      Conclusions

      Pediatric primary care redesign focused on sharing tasks between RNs and physicians can promote teamwork and address unpredictability in clinical settings.

      Practice implications

      Resolving questions about how redesign influences patient continuity and trust, and clarifying optimal staffing may help facilitate adoption of clinical team and workflow innovations.

      Keywords

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