The nation’s opioid epidemic has created a class of tiny, heartbreaking victims—infants who go through opioid withdrawal after being born to opioid-addicted mothers. Traditionally, these newborns have been treated with morphine and have had to endure long hospital stays in neonatal intensive care units.
But Yale’s Matthew Grossman, MD, has developed an innovative new approach to caring for these babies, one that stresses non-pharmacological interventions and that utilizes the bond between parent and child as a first-line treatment. Dr. Grossman’s novel approach has been highly successful and has earned national attention, as hospitals around the country strive to replicate his work.
It’s just one of many reasons why Grossman recently was presented with Yale Medicine’s fourth annual Excellence in Quality and Safety Award. The award was established in 2014 to honor Yale Medicine clinicians who have made significant contributions by leading quality and safety initiatives, improving quality and safety in patient care, and creating a positive and collaborative culture.
Grossman, who is an assistant professor of pediatrics at the Yale School of Medicine and quality and safety officer at Yale New Haven Children’s Hospital (YNHCH), was selected for the prestigious award from a pool of 18 nominees. “He’s had an enormous impact on quality here at Yale and around the country,” says Ronald Vender, MD, chief medical officer of Yale Medicine and chair of the award selection committee.
Newborns and Opioid Withdrawal: A Revolutionary Approach
Grossman is responsible for a number of highly effective quality and safety initiatives, but his highest profile work has involved the treatment of infants born to opioid-addicted mothers. Many of these babies develop a condition known as neonatal abstinence syndrome (NAS).
He challenged the conventional approach of treating infants with NAS in the high-stimulation environment of the neonatal intensive care unit (NICU), where parents are not able to participate in the care of their babies. Instead, Grossman developed a new approach that bypassed the NICU and placed infants with NAS in private rooms with their parents. Rather than treating the newborns with morphine, he stressed non-pharmacological interventions such as a low-stimulation environment; frequent feedings, consoling and swaddling; and parents serving as the front-line caregivers. Having mothers care for their babies in the hospital not only provides comfort to the infants, but it helps the mothers gain confidence and overcome the guilt and shame they may feel about having used opioids during pregnancy.
“The moms are the treatment for the babies, but the babies are also the treatment for the moms. It is entirely family-centered care,” Dr. Grossman says. Empowering parents to comfort and care for their newborns in the hospital “is not a way to deliver care—it IS the care.”
The results of Grossman’s approach have been dramatic. Nationally, the average hospital stay for a newborn going through opioid withdrawal is approximately 21 days; at Yale New Haven Children’s Hospital, the average length of stay is under six days. The proportion of babies with NAS who receive morphine at YNHCH has dropped from 98 percent to under 10 percent.
As a result of this groundbreaking work, Grossman and his team were presented with the 2016 Pediatric Quality Award by the Children’s Hospital Association.
Grossman has shown exemplary dedication, enthusiasm and leadership in furthering the quality and safety culture within the Pediatrics Department at Yale New Haven Children’s Hospital.
Adam Berkwitt
See a video about Dr. Grossman’s work produced by The Schwartz Center for Compassionate Healthcare.
Enhancing the Quality and Safety Culture
As the quality and safety officer at Yale New Haven Children’s Hospital, Grossman has led a wide range of initiatives that have enhanced patient care and created a more positive and pro-active culture with regard to quality and safety.
“Grossman has shown exemplary dedication, enthusiasm and leadership in furthering the quality and safety culture within the Pediatrics Department at Yale New Haven Children’s Hospital,” wrote colleague Adam Berkwitt, MD, in a letter nominating Grossman for the Excellence in Quality and Safety Award.
Here are just a few of the quality and safety initiatives that Dr. Grossman has led:
- The establishment of a “Morning Safety Huddle” at YNHCH, which brings together nursing and medical leadership from all areas of the hospital to discuss safety events. All events are documented and require follow-up to ensure that issues are addressed in a timely manner.
- A children’s hospital-wide effort to reduce central line-associated blood stream infections (CLABSI), which has resulted in a 47 percent reduction in CLABSI to date.
- A children’s hospital-wide effort to reduce catheter-associated urinary tract infections (CAUTI), which has resulted in a 75 percent reduction in CAUTI to date.
- A national effort implemented in the pediatric and neonatal intensive care units to reduce unplanned extubations, which has resulted in a 45 percent reduction in events to date.
- The development of an innovative quality improvement mentoring program for pediatric residents, in which residents are divided into teams that design and implement quality improvement projects and present their results.
- An increase in the transparency of YNHCH safety metrics, including public reporting of safety data on the hospital website.
- A substantial improvement in the number of serious safety events at YNHCH. In 2016–17, YNHCH went more than 650 days without a serious safety event.
Grossman earned his medical degree from Stony Brook School of Medicine in New York and did his residency in pediatrics at Yale. He lives with his wife, Millie VandenBroek, and sons Levi, 5, and Oscar, 8.
He says he is honored to receive the Excellence in Quality and Safety Award, but he sees it as a team award rather than an individual recognition. “This work is a real team effort,” Grossman says. “It’s wonderful to have our team recognized.”