During 2019 institutional mortality reviews, it was noted that many deceased babies who received care in the neonatal intensive care unit (NICU) did not have a discharge summary. Discharge summaries provide vital information for general practitioners (GP). GPs are important contributors to ongoing care for bereaved families, but their capacity to do so may be limited if they have not received information regarding the child’s death. 

This quality improvement project aimed to increase discharge summary completion rates to greater than 80% for deceased infants that received some of their care in the NICU. 

A retrospective audit of the NICU database and electronic medical record was conducted for the calendar year of 2018 to identify deceased infants. It was then determined whether they had NICU care and a completed discharge summary.

Using a quality improvement framework, potential interventions to improve discharge summary completion for deceased infants were explored. The chosen intervention was a checklist sticker placed at the end of the patient chart, to confirm completion of key administrative tasks, including the discharge summary. 

After implementation of the sticker, a further retrospective audit reviewed a six month period.

Retrospective audit of 2018 identified 42 infants who died and were cared for in NICU at some time. Only 55% had a completed discharge summary.  Development of the checklist sticker and progression through institutional review processes took approximately 12 months. Following education of staff, roll out occurred in March 2020. Re-audit occurred in February 2022, reviewing May to November 2021. Discharge summary completion rate was 100% for these 17 infants. 

Further development of the sticker is planned, including use as a memory aid for other key administrative and practical tasks identified as needing improvement at the completion of an admission involving end of life care.