NICU to Home: Ensuring quick access to care

When a family envisions the arrival of their newborn, a stay in the neonatal intensive care unit (NICU) is likely not in the plan.

For many with a baby in the NICU — whether for a short stay or a months-long one — the need for a higher level of care doesn’t stop when they go home. The transition can be complicated, overwhelming and sometimes a long waiting game for next steps.

At MultiCare Yakima Memorial Hospital, the NICU to Home program has changed that.

Through a collaborative venture, Early Support for Infants and Toddlers (ESIT) guidelines were adopted in the Yakima Memorial NICU to provide families with evaluation and acceptance into the Children’s Village program before they leave the hospital. ESIT provides therapy and other support services in a family’s home, on a more flexible schedule to fit their lives.

Previously, upon discharge a family would need to schedule an outpatient evaluation to receive ESIT services, and then wait for their intake appointment with Children’s Village before services could begin.

“In the NICU, we saw families who had babies in need of 24-hour care who were going home and having no form of support for months at a time,” explains Mackenzie Franke, occupational therapist and clinical supervisor at Children’s Village. “We wanted to reduce that wait time.”

The Children’s Village program focuses on children with the highest needs, such as genetic conditions, prematurity or other diagnoses that could impact their development, and those who have been discharged with a feeding or oxygen tube, explains Franke.

“The transition from NICU to Home was easier than expected, just a bit scary. Lillian came home on oxygen and with a feeding tube. I had to learn how to get around with oxygen, but I figured it out pretty quickly. We were blessed to have an amazing team that followed us out of the NICU, including our home therapist Mackenzie.”

— Brandy, mother of Children’s Village child

Since its implementation in 2021, NICU to Home has helped more than 25 families get into ESIT faster. Babies discharged from the Yakima Memorial NICU are beginning ESIT therapy services an average of 7.25 days after discharge, compared to the previous average of 64 days.

“Any family who has had a baby understands how hard it is to make it to everything and get everything done, especially when they didn’t have a normal or expected birth plan,” Franke says.

Getting families set up with their next steps before leaving the NICU makes it a more seamless process and takes off some of the mental load, adds Claire Bange, speech language pathologist at Children’s Village.

“The population of Yakima includes historically marginalized and low socioeconomic groups,” Bange explains. “Combined with the higher population of children when compared to other counties in Washington, it places strain on the medical system to support families and meet them where they’re at.”

It can be a challenge to find the time to schedule and make these appointments after returning home and to work, Bange says. Children’s Village serves all of Yakima and Kittitas County, primarily rural communities with minimal options for services.

“These families need and want these services,” Bange adds. “We’re able to connect all these dots and take advantage of our unique situation as partners between Yakima Memorial and Children’s Village.”

In years past, pediatric therapists from Children’s Village would visit the NICU on an as-needed basis to evaluate and care for infants. That has since evolved to four Children’s Village therapists on-site each week to ensure every infant is evaluated, Franke says.

“We’ve gotten great feedback from families who didn’t even realize they were in the ESIT program now because the transition from the NICU to ESIT was so seamless,” Bange says.