Variations among US hospitals in counseling practices regarding prematurely born infants.
OBJECTIVE
We studied several counselor-independent elements of prenatal counseling regarding prematurely born infants. Elements studied include: indications to offer counseling, clinical settings in which counseling is offered, personnel assigned to counsel, availability of tools to assist counseling and post-counseling documentation requirements.


METHODS
As the study aimed to explore system-based practices and not counselor-based practices, we surveyed Neonatal Intensive Care Unit medical directors.


RESULTS
Responses were received from 352 hospitals (53%) in 47 states. Analysis was based on responses from the 337 hospitals that routinely counseled women anticipating a premature birth. In 299 (≈ 90%) hospitals, counseling was primarily performed by neonatal professionals. Premature labor was the most common indication to offer counseling; however, in 54 hospitals most counseling was offered before labor and based on maternal risk factors for preterm delivery. In nearly all (99.7%) hospitals information was provided verbally and face-to-face; a third of the hospitals also provided written information. For non-English-speaking Hispanic patients, 208 (62%) of the hospitals had certified hospital-based Spanish interpreters. Five (1%) hospitals provided specialized training to the designated prenatal counselors. The upper gestational age eligible for counseling at all 337 hospitals included 33 weeks; in 134 hospitals, gestational age of <23 weeks was not eligible for counseling.


CONCLUSIONS
Antenatal parental counseling for premature delivery is a widely practiced intervention with substantial system-based variability in execution. Interventions and strategies known to improve overall counseling effectiveness are not commonly utilized. We speculate that guidelines and tool-kits supported by Pediatric and Obstetric professional organizations may help improve system-based practices.
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
A
A
Mehrotra
J
J
Lagatta
P
P
Simpson
U Olivia
UO
Kim
M
M
Nugent
M A
MA
Basir
D003376:Counseling / Q000706:statistics & numerical data*; D004282:Documentation; D005260:Female; D005865:Gestational Age; D019538:Health Care Surveys; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D010818:Practice Patterns, Physicians'; D014481:United States