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Date and Duration: August 2024 – March 2025

Eat, Sleep, Console (ESC) Community of Learning (COL)

Purpose

The opioid crisis continues to affect vulnerable populations, including newborns exposed to opioids in utero who often develop Neonatal Opioid Withdrawal Syndrome (NOWS). Traditional treatments rely on medications and prolonged hospital stays, which can be costly and challenging for families. The Eat, Sleep, Console (ESC) method offers a compassionate, family-centered alternative that prioritizes non-pharmacological care and addresses newborns’ basic needs. By reducing medication use and improving outcomes, ESC provides a holistic, evidence-based approach to managing NOWS.

ESC Chart
References

1. Patrick S, Barfield W, Poindexter B. Neonatal Opioid Withdrawl Syndrome. American Academy of Pediatrics. 2020;146(5). doi:https://doi.org/10.1542/peds.2020-029074

Goals & Objectives

1. Enhance the implementation of the Eat, Sleep, Console (ESC) method to improve care coordination and outcomes for newborns with Neonatal Opioid Withdrawal Syndrome (NOWS)

2. Minimize separation of the parent-child dyad by fostering processes that actively involve parents in their newborn’s care

3. Reduce the need for pharmacological therapy and ensure appropriate lengths of stay

4. Provide tools, resources, and a collaborative space for hospitals to share experiences and strengthen ESC implementation at all stages

How Success Is Tracked

A family of measures is a set of related metrics used in Quality Improvement (QI) initiatives to assess the overall impact, outcomes, and processes of a project. These measures provide a comprehensive picture of the initiative’s effectiveness and guide decision-making. A family of measures typically includes three types of metrics:

Outcome Measures

Definition: Metrics that reflect the ultimate goals or results of the initiative, focusing on the impact on patients, populations, or systems.
Purpose: To evaluate whether the initiative achieved its desired results.

Process Measures

Definition: Metrics that assess whether specific actions or interventions were implemented as intended. These focus on the steps or processes involved in achieving the outcome.
Purpose: To monitor the implementation and effectiveness of the processes driving the outcomes.

Balancing Measures

Definition: Metrics that ensure improvements in one area do not negatively affect other areas. They check for unintended consequences or trade-offs.
Purpose: To ensure that changes made to improve one outcome do not create new problems elsewhere.

Family Of Measures

Outcome Measures:

1. Percent of time in a 24 hour period birth parents/caregivers of newborn with NOWS (or enrolled in ESC) were present
2. Length of stay in days for newborns exposed to opioids

Process Measures:

1. Percent of newborns exposed to opioids rooming in with parents
2. Percent of newborns exposed to opioids discharged to either birth parent

Balancing Measure:

Percent of readmissions within 30 days of postpartum hospital discharge due to NOWS or related complications

Optional Measures:

1. Percent of birthing people receiving prenatal and/or delivery admission screening using a validated universal tool
2. Percent of newborns with NOWS referred for early intervention
3. Feeding method for newborns with NOWS
4. Rate of newborns with NOWS or at risk of withdrawal receiving non-pharmacologic first-line intervention
5. Transfer rate of newborns with NOWS or at risk of withdrawal

Toolkit

Our toolkits provide targeted resources specific to each QI program, offering essential materials to support healthcare teams in achieving improvement goals.

AIM Bundle – Care for Pregnant and Postpartum People With Substance Use Disorder
ESC Neonatal Clinical Pathway
AAP – Reduction in LOS and Morphine Use With ESC Method
NICHQ – A Mother Centered Approach to Treating NAS
Task Force on Pregnancy Health and Substance Use Disorders

MNPQC’s Quality Improvement Programs were developed with support and guidance from hospital teams and professional faculty throughout the state of Minnesota. The contents do not necessarily represent the official views of, nor an endorsement, by MNPQC or our partners.