P3.194: Implementing a Health Equity Initiative in the Neonatal Intensive Care Unit

Purpose/Objectives: Inequity in healthcare impacts outcomes in medicine including neonatology. In our culturally diverse neonatal intensive care unit (NICU) perceptions of prejudice and bias were reported by pediatric trainees, alerting leaders to possible disparate care. We aim to implement an educational initiative on health equity in the NICU targeting all providers, with the goal of reducing disparities in care.

Design/Methods: The Health Equity in the NICU (HEN) Initiative began in June 2024. Our first intervention was “HEN Huddles,” a monthly lecture and discussion series for pediatric residents rotating in the NICU, aimed at fostering a safe environment to express concerns and share personal experiences related to bias and racism. We created an anonymous and unlinked REDCap survey to assess perceptions of biases and healthcare disparity using Likert scales and free response. Participants completed the survey pre- and post- HEN Huddle. A QR code of the survey was widely available and captured pre-huddle data. T-tests were used to evaluate significant changes in pre- and post-huddle responses.

Results: There have been nine HEN Huddles and 85 survey responses. Respondents represented a diverse group working in the NICU including medical students, nurses, trainees, and attending physicians. Fifty-five of the responses were pre-huddle, and 30 were post-huddle. Qualitative themes included recognizing disparate care for non-English speakers, judging of parents for absence, and a paucity of resources for parents with food insecurity. We found significant improvement in agreement with three items; Q5: “Individual biases can affect patient care” Q7: “Individual biases can impact the healthcare team's approach to patient care” and Q12: “I feel comfortable talking about race and social determinants of health.” Pre-huddle, average Likert scores were 4.7, 4.5, and 3.9, and post-huddle averages were 4.9, 4.9, and 4.4 respectively (p=0.036, p< 0.001, p=0.007 respectively). For both pre- and post-huddle surveys, Q6: “I am aware of my own biases” and Q11: “The NICU is a diverse and inclusive work environment” were relatively low without significant improvement; pre-huddle Likert scales were 3.9 and 3.8 and post-huddle were 4.1 and 3.9 respectively (p=0.065 and p=0.87 respectively).

Conclusion/Discussion: Results indicate that the first step in our initiative has helped participants recognize bias can affect patient care and the team's approach to care as well as feel more comfortable discussing health disparities. We hope to provide a wider forum for discussion and find actionable changes such as providing in-person interpreters and creating a more inclusive work environment. Next steps include nurse focused huddles, gathering data on family perceptions, and multi-disciplinary discussion panels.