The Colorado Hospitals Substance Exposed Newborn Quality Improvement Collaborative: Standardization of Care for Opioid-Exposed Newborns Shortens Length of Stay and Reduces Number of Infants Requiring Opiate Therapy.

OBJECTIVES: To decrease the average length of stay (LOS) of opioid-exposed newborns (OENs) by 20% from baseline from April 2017 to December 2019. METHODS: The Colorado Hospitals Substance Exposed Newborn Quality Improvement Collaborative is a consortium of neonatal providers, public health experts, and legislative experts that provides infrastructure and resources for Colorado birthing hospitals to undertake initiatives focused on improving the care of OENs. The Colorado Hospitals Substance Exposed Newborn Quality Improvement Collaborative was started in September 2017 and includes 19 birthing hospitals in Colorado, with 12 contributing data to the centralized database. The interventions were focused on (1) hospital engagement and (2) increasing nonpharmacologic care (by using the Eat, Sleep, Console assessment tool; developing guidelines for breastfeeding eligibility; employing comfort measures before pharmacologic therapy; and administering opiate therapy on an as-needed basis). RESULTS: From April 2017 to December 2019, 787 OENs were identified. Among infants ≥35 weeks' gestational age without other medical diagnoses (n = 647), statistical process control charts revealed significant reduction in the primary outcome of interest, average hospital LOS, from 14.8 to 5.9 days. For all OENs, receipt of pharmacologic therapy declined from 61% to 23%. Among OENs who received pharmacologic therapy (and were ≥35 weeks' gestational age without other medical diagnoses), average LOS also declined from 21.9 to 8.0 days. CONCLUSIONS: Through standardization of OEN care focused on family engagement and nonpharmacologic care, this statewide collaborative reduced average LOS, the percentage of OENs requiring opiate therapy, and average LOS for OENs requiring opiate therapy.

Effect of school closure on the incidence of influenza among school-age children in Arizona.

OBJECTIVE: We assessed the impact of school closures as a viable intervention in the event of an influenza pandemic. METHODS: We evaluated the effect of scheduled, two-week winter break school closures during the 2004-2008 school years on the occurrence of influenza among children aged 5-17 years in Arizona. RESULTS: We found a consistent pattern of benefit to school-age children during winter school closures when non-school-age children and adults experienced significant increases in influenza incidence, an increase not seen among school-age children. Quantitative analysis showed that school closures may prevent or delay as much as 42% of potential influenza cases among school-age children. In addition, the ratio of illness in school-age children as compared with adults and non-school-age children decreased significantly from before to during the same school closure periods. CONCLUSION: This analysis provides evidence to suggest that school-age children may experience a slowing of influenza transmission during winter school closures compared with those not of school age. Federal, state, and local policy makers may consider these findings in their pandemic influenza and public health emergency preparedness planning efforts.