Discharge Planning and Follow-Through Care

Discharge Planning and Follow-Through Care 1. Systems will be in place to establish preparation for NICU discharge, including post-discharge follow-up by general and subspecialty pediatric care providers, home care arrangements and community service resources, and enrollment in a developmental follow-up program as needed. The facility must have written medical, neurodevelopmental, and psychosocial criteria that automatically warrant high-risk neonatal follow- up with appropriate developmental follow-up services; as well as provide developmental follow-up services or have written referral agreement with a developmental follow-up clinical or practice, when possible, to provide neurodevelopmental services for the neonatal population served. a. Follow-up outcomes are monitored via the Neonatal PI Plan to ensure continuity of care.