Story of Merge: Episode 3

The ‘holy grail’ health services is typically considered achieving the Quadruple Aim, which is (1) better patient and family experience, (2) better population health outcomes, (3) better healthcare professional well-being, and (4) reduced cost. Typically, health systems pay more, not less, for higher quality care. We wanted to know if Merge^TM was indeed the holy grail of health services and whether improving family-centred care could benefit other parts of the health system.

With Merge^TM, roles in the neonatal intensive care unit (NICU) change dynamically as parents become true partners in the care of their infant. One father described “parenting with supervision” as he was being educated to care for his baby in preparation for discharge. When taking her baby home, one mother said, “We started off with the nurses providing all her care. Three weeks later, we were doing it all.” In a series of studies, Merge^TMdemonstrated better quality of care at lower cost to the health system. How did we do that?

Co-designed with parent and neonatal care providers, Merge^TM training for neonatal care professionals includes 2-hour asynchronous interactive learning modules delivered online as part of a unit-wide, standardized implementation process. With research funding for a cluster randomized controlled trial in level II NICUs, Merge^TM demonstrated efficacy for parents, babies, and the health system. Notably, parents were less distressed and more confident. Babies received less invasive medical interventions and had shorter time to first skin-to-skin care. Babies were discharged 2.55 days sooner and without achieving the traditional criterion for discharge, which is regaining their birthweight. Earlier discharge from NICU did not result in more emergency department visits or readmissions and the health system avoided costs. As they grew up, babies had a slightly decreased risk of developmental delay.

However, these results were from the controlled environment of a clinical trial. We wanted to know what would happen if Merge^TM were implemented in the ‘real world’ with every preterm baby admitted to any type of NICU including level II, level III, and surgical NICUs.