Our Health System is Failing our Most Fragile and Vulnerable Population and I am Part of The Problem

On average once an hour a former premature infant is sent home from the hospital on oxygen support along with other supporting tools- suction, gavage tube feedings, old school monitors that beep and buzz the list goes on and on. Premature infants who one moment ago were "miracle infants" in an ICU with a nurse at the bedside 24/7 are now "NICU Grads" and after holding a graduation party and sent out the door for the parents to fend for themselves. No remote monitoring or support, no support hotline, not even an instruction manual. You can come to our annual NICU grad party but loose our number the NICU is behind you. If you need help call your Pediatrician, or 911. Is it no wonder that Facebook groups dedicated to the families of NICU grads are bursting with stories of parents trying to help each other out forming mash unit support groups?

As a Neonatologist I am part of the team that helps save and takes care of these delicate patients in the hospital and ultimately it is my decision to say when a baby is safe to go home. Parents often say doctor " I am willing to stay as long as it takes, I just want to know that they are like normal newborn when the go home." The truth is though that I do not have a good answer of when that day arrives that it is safe to be discharged home. Yes there are guidelines and recommendations but in reality they do not work because our post discharge readmission and mortality rates surpass those of multiple adult chronic conditions. There is not a single Neonatologist who has managed premature infants who has not told a family that there child is ready to go home only to find out that they died the following week at home.

Six years ago that is what happened to me, I sent another former premature infant home on oxygen, a 40 page copy of my hospital discharge note, an appointment with a Pediatrician they never met before, and a congratulations- only to find out that infant died the following week. After hearing that terrible news, I made a promise to myself that day that if the healthcare industry would not supply me with the tools I needed to help these parents that I would do it myself. On that that day 5 years ago Firstday Healthcare was born, at least in my head. I would build a virtual NICU at home and provide parents utilizing tools that already existed all the benefits the hospital provides but in the comfort of the families home.

It has not been an easy journey since than and everyday is like trying to swim upstream against the current. Many of the goals Firstday is trying accomplish goes against the healthcare industry who wants more NICUs bigger NICUs churning out intensive care level billing. Decrease readmissions? NICU grads fill the PICU. Needless to say value based care is slow to come around and fee for service is still the dominating player.

Payers of healthcare are desperately looking for tools to decrease NICU expenditure and while digital health tools exist to support maternal care to decrease NICU admissions the truth is that NICU utilization rates are constantly increasing and once in the NICU it is like a black box the patient is ours, no going anywhere, and many in healthcare are content with that.

The good news is we are making progress. Our wireless monitoring and management platform is already fully functional and being tested in hospitals and making easier entry in healthcare systems outside of the USA where incentives align more in getting the patient home sooner and keeping them there safer longer. We are gaining momentum, gaining supporters and backers, and I am beginning to see the light at the end of the tunnel. I have no doubt Firstday Healthcare will succeed and will not rest until every NICU graduate is offered our tools to give each one the best chance to live a long and healthy life; our fragile vulnerable infants deserve it lets not let them down any longer.