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.method:as the study aimed to explore system-based practices and not counselor-based practices, we surveyed neonatal intensive care unit medical directors.result: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.conclusion: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.