Devices & Technology

Crib Notes Brings NICU Data Together

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By Suzi Birz, principal, HiQ Analytics

Over the past several years, advances in medical technology have increased the survival rate for infants in the neonatal intensive care unit (NICU). The number of babies treated in the NICU is rising as is the length of stay, as the babies “arrive” younger. Coupled with ever-increasing time pressure, nurses in the NICU may welcome the opportunity to improve communication and patient safety and spend more time with the babies and parents. Thanks to the new Crib Notes technology, this opportunity has now arisen.

Crib Notes was developed by the president of Grand Round Software, Robert Stavis, Ph.D., M.D., chair of the department of pediatrics and clinical director of the NICUs at Main Line Health in suburban Philadelphia, Pennsylvania. About a decade ago while working at the bedside, Stavis wanted a way to follow and track the outcomes of patients in the NICU. Since that time, Crib Notes has developed into a complete electronic health record for NICU babies, commercially available and in use at four NICUs.

“The primary goal was to improve the quality and safety of care of patients in the NICU,” Stavis explained.


Crib Notes is organized around the workflow and documentation already used in NICUs. The software serves all those who participate in the care of babies. It provides tools to use the data to advance NICU medicine.

“Care begins with nursing data,” Stavis said.

The system is used at the bedside by nurses who are gathering data. Calculations from nursing and summary data are defaulted into the physicians’ admission notes, progress notes and discharge summary so that doctors do not have to spend time gathering information about the babies.

Nurses are presented with familiar-looking, easy-to-use screens for charting and data entry. According to Kim Flanagan, RN, BSN, this allows the charting to be completed more quickly. Prompts are provided by the system to ensure thoroughness while enabling the nurse to return to caring for the baby. Quality-assurance reminders are built into the system in support of key compliance monitors. In the event that certain data was expected at a specific time, a reminder will be sent to the nurse if that data is not recorded at that time.

Respiratory therapists, physical therapists and social workers chart their progress notes in the system. Consulting physicians who had routinely left illegible notes for the NICU nurses and physicians now enter their notes in Crib Notes. Having all the data available greatly enhances communication about the patient. Case managers review the data online and are able to see all the data in one place from all the caregivers and over the entire length of stay.

Parent Communication

In an effort to enhance communication with the parents of NICU babies, Crib Notes has a parent e-mail feature. Nurses review and personalize the system-generated text, which summarizes the flow sheet data about the baby's weight, I&O and other clinical variables. These e-mails, which are written in “first person” from the baby, have been well-received by the parents, Stavis said.

Caregivers use the system when speaking with parents, browsing through the record.

“One way to show a baby’s progress—in face of what might appear to be no progress—is to show and give a copy of the growth chart,” explained Cindy Cox, a neonatal nurse practitioner at Alfred I. duPont Hospital for Children in Wilmington, Delaware. “Parents collect and keep the growth charts and e-mails in their baby book.”

Clinical Database

Stavis detailed that the data is available and useful across the patient population as well as for the individual baby. The system provides the tools that are critical to “understanding what is going on in the NICU and tracking the results of patient care,” he explained. The data supports the peer review and quality assurance processes. Structured diagnoses allow for morbidity and mortality reporting, and the system allows examination and reporting of condition combinations, treatment success, outcome follow-up and research queries.

Ease of Use

Crib Notes requires very little training beyond an orientation. The ease of use is evident by the wide variety of users of the system. Consultants and therapists that spend only part of their day in the NICU are using the system just as the ever-present nurses and physicians do. Flanagan noted that float and temp nurses get an overview and orientation to the system and then adapt very quickly to charting on the system.

Notable Benefits

The system does some of the repetitive tasks and tracking that nurses are routinely required to do and that take time out of the patient care hours. The system does I&O math, noted Cox, all but eliminating the calculation errors associated with fluids and nutrition. There is a built-in breast-milk identifier using barcode technology, allowing the milk to be labeled by the mother and provided to the appropriate baby or babies.

Flanagan stated that the quality assurance aspect is improved because the data represents information from all the caregivers and it is organized, helping to ensure that what is supposed to be done is done.

“The system does not do the thinking for the physicians, but it helps ensure that the caregivers are making informed decisions,” Stavis added.

Take-Away Messages

“Crib Notes helps you do your job better and more efficiently while increasing patient safety and compliance,” Stavis asserted. “The integrated medical and regulatory documentation makes the work of taking care of patients easier.”

Cox added: “There is improved communication between physicians, nurses, neonatal nurse practitioners, ancillaries and all consultants, and therefore improved patient care and safety.”

Flanagan reflected on her four years of use of Crib Notes: “[It] has made my job easier than anything else I have come into contact with in eight years of NICU nursing. It allows me to focus on patients and spend less time on tasks and documentation.”

For more information, visit the Crib Notes or Main Line Health Web sites.

© 2005. AMN Healthcare, Inc. All Rights Reserved.

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