Improving parental consultation within 24 hours of admission - a case study for NNAP

This case study from The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust was included in the 2018 annual report on 2017 data, and highlights how some neonatal units have used NNAP results as a basis for identifying, and undertaking, local quality improvement activities.


Communicating to families about their baby’s progress is very important. When the services at The Royal Oldham Hospital were first developed into a level 3 NICU (Neonatal Intensive Care Unit) we made a big improvement increasing the percentage of parents spoken to from less than 50% to 86% - a level that was comparable with our peers and other level 3 units within the network.

However, despite regular communication and reminders, we had been unable to improve on the number of parents who were seen by a senior member of staff within 24 hours of admission.

In 2014 we spoke to 84% and in 2015, 86%. While reviewing the 2016 data in February 2017 it became apparent that this had not improved despite there being a general improvement across the UK. We suspected we would be an outlier (which we were), so we put a plan in place to try and improve our documented communication.

What we did

We measured the percentage of parents spoken to for all patients that were admitted to the neonatal unit - not just those that fulfilled the NNAP criteria - and put them in a run chart. 

In March 2017 we - a consultant neonatologist and data quality clerk - worked together to devise a run chart that looked at the percentage of parents that were spoken to on a weekly basis. The clerk checked the BadgerNet data quality of all the babies admitted in the past week, and complete the spreadsheet. She would then print off the chart each week and display on the staff noticeboard. 

For the first few months the results were mentioned at the communication meeting. While this was officially anonymous, consultants could identify themselves as we attend the unit for a week. 

Consultant colleagues agreed that we needed to improve and were happy to trial this. Once in place they requested that if a consultant spoke to 100% of parents that they would receive a gold star.

What we achieved

  • Our 2017 results have improved to 94%.
  • Consultant colleagues were very enthusiastic about this and worked hard to make sure it was successful. In fact they became very competitive and the gold star was their idea.
  • Within a few months there was a definite attitude change, with medical staff always including first consultation as part of the presentation of an admission.
  • Despite less frequent updates, this improvement appears to have been sustained - though there is still room for improvement, particularly for those patients who remain on the unit for a short period of time or for an intervention.

Top tips for implementation

  • You need a dedicated member of staff who can check the data and update the graph weekly.
  • Consultants are amazingly competitive.

Presented by

Dr Natasha Maddock, Consultant Neonatologist and Mrs Beverley Scholes, NICU Data Quality Clerk

The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust


We thank the Clinical Lead at Arrowe Park, Dr Oliver Rackham, for sharing his project.

If you would like a copy of the spreadsheet used by The Royal Oldham Hospital to devise their run chart, please contact