Hospital Referral Guidelines

Michigan Health and Safety Coalition Hospital Referral Guideline for Low Birthweight Infants*

• Neonatal Intensive Care Units (NICUs) caring for low birthweight infants (see Appendix A for a list of codes) should possess the following structural characteristics:

1. a board-certified or board-eligible neonatologist should direct the NICU;
2. 24-hour in-house coverage should be provided by either a physician qualified in the intensive care of newborn infants or by an appropriately trained physician extender; and
3. physician backup to the physician extender should be available within 30 minutes.

• Collect risk-adjusted morbidity and mortality data for all Michigan NICUs via the Vermont Oxford Network or develop a data procurement mechanism from Michigan sources by May 2002.

• Work with the Society of Michigan Neonatologists and other organizations to identify and convene Michigan physician and nurse practitioner neonatal and perinatology experts to:

1. establish and periodically review hospital-specific standards and guidelines for selected NICU quality of care indicators such as mortality, complications, access to specialty care and other services, NICU admission criteria, and NICU nurse staffing levels;
2. update the proposed guideline according to NICU quality of care indicators and consider whether the guideline should be more rigorously defined (e.g., low birthweight as 750-1000 grams rather than 1500 grams);
3. review and analyze risk-adjusted morbidity and mortality data (e.g., neonatal survival statistics by weight and gestational age);
4. evaluate hospital-specific performance relative to agreed upon standards and guidelines; and
5. disseminate hospital-specific performance information with physicians, hospitals, and the Michigan Health and Safety Coalition.

• Hospitals with Neonatal Intensive Care Units (NICUs) should admit at least 70 low birthweight infants (<1500 grams) on an annual basis.

• Hospitals should require that their medical staff implement appropriateness criteria and use the criteria to conduct clinical case review of all NICU admissions.

* This is meant to be a guideline and not a standard of care; this guideline represents the best of an evidence-based review at this time; the guideline is based on the principles of CQI and is not intended to be used in a punitive manner; this guideline needs to be taken as a whole, and not have selected parts be used without considering the entire content of the guideline.