Improvements to two year follow up assessments for at risk neonates in a district general hospital setting - a case study for NNAP

This case study was included in the 2017 National Neonatal Audit Programme annual report to highlight how a neonatal unit has used its results from the National Neonatal Audit Programme as a basis to identify and implement local quality improvement activities. You can download the full case study below.


Woodland Neonatal Unit at Watford General Hospital, West Hertfordshire NHS Trust caters for up to 1200 admissions per year. It is one of the busiest level 2 units within the East of England Neonatal Network. The unit has contributed data to the NNAP since its inception in 2007.

Completion of two year outcome assessment forms for babies born less than 30 weeks gestation was less than satisfactory (≤80%) in 2013/2014. Moreover, none of this cohort of babies had a formal neurodevelopmental assessment. In this case study, we demonstrate how we have used NNAP two year follow up data benchmarks to guide our quality improvement project.

We show how we improved data completion rates while at the same time increasing the proportion of babies who had a formal developmental assessment.

What we did

We arranged for brainstorming sessions between all relevant stakeholders to identify key areas for improvement and discussed potential solutions.

The team considered providing home visits as a regular service, but due to staff working patterns and constraints, we were only able to provide that for two patients (at parent’s request). A specialist clinic was set up to improve compliance. The team included a neonatologist, physiotherapist and a clinic coordinator. Eligible infants born at less than 30 weeks were prioritised. Appointments were given on discharge and reminders and alerts were set up for 18-30 months range. Bayley Scales of Infant & Toddler Development III (BSID) were used for the assessments. A BadgerNet data analyst was appointed to facilitate real time data monitoring which allowed zero latency feedback to the lead consultant.

What we achieved

There was steady improvement from 2013 to 2017 in the results for the NNAP audit measure of 2-year health status follow-up completion.

There was a small decline in 2016 as two babies were seen outside the 18-30 months’ target.

BSID assessments increased from 0 in 2013 to 75% in 2017. DNA rates increased initially in 2015 on introduction of the Bayley Assessment Clinic but using iterative PDSA cycles this was brought down to 6% in 2017.