Hello Friends 👋
Join Ben and Daphna on this week’s Tech Tuesday as they spotlight NICU2Home, an innovative app designed to support NICU families from admission through discharge. Guests Dr. Craig Garfield and Nicole Nyberg discuss the app’s evidence-based features, including tailored education, daily updates, and a dynamic roadmap for discharge milestones. NICU2Home enhances parental confidence, improves discharge preparedness, and strengthens social support, particularly in diverse populations. The team also highlights seamless integration with Angel Eye systems and how the app benefits NICU staff. Tune in to explore how NICU2Home is transforming care for families and providers alike.
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Short Bios:
Dr. Garfield : Dr. Craig Garfield is a Professor of Pediatrics and neonatal hospitalist with over 25 years of experience. He co-founded NICU2Home, an evidence-based app supporting NICU parents, now part of AngelEye Health. Guided by his motto, “Children thrive when families thrive,” his work focuses on empowering families through innovative care and research. Dr. Garfield trained at Rush Medical College, Massachusetts General Hospital, and the University of Chicago, earning a Master’s in Public Policy as a Harris Child and Family Scholar. His research, funded by NIH, AHRQ, and others, combines data-driven methods with advocacy for unheard voices.
Nicole Nyberg: Nicole Nyberg, MSN, APRN, NNP-BC, is a dedicated Neonatal Nurse Practitioner and the mother of a former 23-week preemie. She is the Founder and CEO of Empowering NICU Parents, an organization committed to providing education, support, and empowerment to NICU families and clinicians. Nicole hosts the “Empowering NICU Parents Podcast” and authored “Our NICU Roadmap,” a daily journal designed to guide parents through their NICU journey. Her personal experience as a NICU mother fuels her passion for enhancing family engagement in neonatal care, emphasizing the positive impact of parental involvement on infant development.
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Articles discussed in this episode can be found below 👇
Supporting parents of premature infants transitioning from the NICU to
home: A pilot randomized control trial of a smartphone application
Craig F. Garfield a,b,c,⁎, Young Seok Leea, Hyung Nam Kima,1, Joshua Rutsohnc, Janine Yasmin Kahna,Brian Mustanski c, David C. Mohr d
Paternal and Maternal Concerns for Their Very Low-Birth-Weight Infants Transitioning From the NICU to Home
Craig F. Garfield, MD; Young Lee, PhD; Hyung Nam Kim, PhD
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The transcript of today's episode can be found below 👇
Ben Courchia MD (00:00.676)
Hello everybody, welcome back to the Incubator Podcast. We are back today with a new episode of Tech Tuesday. Daphne, how are you this morning?
Daphna Yasova Barbeau, MD (00:07.652)
I'm doing great. You know, I love doing Tech Tuesday. They're always so fun. I think we learn a lot. I hope the community learns a lot. And we just love bringing not always new solutions, but attention to solutions that are, I think, really helpful for.
Ben Courchia MD (00:22.855)
Yeah. For people who don't know that's sort of the geek in me who's always wanted to do like gadget reviews and stuff. So that's my way of geeking out and doing. And that's very true what you said. That's the most frustrating part about some of the work that we do with Tech Tuesday is that sometimes you look at something and you're like, my God, this is amazing. And it's like, yeah, it's been out there for like 10 years. And it's like, my God, like why am I only finding out about...
Daphna Yasova Barbeau, MD (00:27.75)
That's right. This is our take.
Nicole Nyberg (00:28.514)
you
Daphna Yasova Barbeau, MD (00:40.646)
That's right. I know. Why don't we know about it? Yeah.
Nicole Nyberg (00:44.583)
you
Ben Courchia MD (00:44.676)
And so we're very excited to bring on the show today two amazing guests coming to us from the team at NICU2Home solution brought to you by the Angel Eye team. And we have Dr. Craig Garfield, who's a professor of pediatrics and the co -founder of NICU2Home. You're also a hospitalist in the NICU. Craig, thank you so much for making time to be on with us this morning.
Craig Garfield (01:08.565)
Happy to be here.
Ben Courchia MD (01:10.284)
We are also joined by Nicole Nyberg, who is a neonatal nurse practitioner and a clinical specialist with NGIL -I team. Nicole, thank you again for being on with us.
Nicole Nyberg (01:21.1)
Thank you so much for having us.
Ben Courchia MD (01:23.176)
And I would like to maybe begin with you, Craig, and dive straight into it, talking about NICU2Home, spelled NICU like we all know, to the number two and then home. And really, this is a solution that is marketed as the first evidence -based NICU navigation and discharge coordination solution. Can you tell us a little bit more about what that means?
Craig Garfield (01:48.993)
Yeah, so it actually calls on about 12 years of research. About 12 years ago, I was walking through the NICU and these newfangled things called cell phones were being used by parents. They were kind of sitting at their bedside playing Tetris while their baby was sleeping. And I thought to myself, you know what, there has to be a better use for these things than playing video games. And at that time, you could only really do either play a video game or make a phone call. You couldn't do more than one thing at one time because of the
processors, and those are changing really quickly. And so my colleague, Young Lee, who is also a co -founder on this, and he's a UX human computer interactions PhD, we were working at Motorola at the time, and we got together and wrote a grant to HRQ to do the very first version of NICU to Home, and we're now on our third version, but that first version really focused on the time that I think in the NICU were a little bit less
excited maybe about those feeders and growers and we're kind of like moving on to like other sick babies. But for the parents, that was the most important time, right? That's when they are moving out of their isolate into an open crib and they have to get ready to go home. And they are suddenly dawns on them like, what am I going to do with this baby at home? Can I bring the nurse home with me? Can I bring the Phil's monitor home with me? And the answer always is no, unfortunately, or fortunately. So we really set out to straddle.
Daphna Yasova Barbeau, MD (02:58.489)
food.
Daphna Yasova Barbeau, MD (03:03.344)
Mm -hmm.
Daphna Yasova Barbeau, MD (03:09.915)
Nothing.
Craig Garfield (03:15.233)
that time from moving into an open crib to actually being discharged and then following up with that going home. And we did an RCT and found that the families that got the app actually had increased parenting self -efficacy, which we think is a really important metric for our parents when we send them home. Do they feel comfortable taking care of their premature baby? They had improved discharge preparedness, according to the press, Ganey. And then they also in the smallest babies, and this was 90 VLBW infants here in Chicago.
those babies actually had one day decrease in length of stay compared to the control group. And what the parents told us when we talked to them was, why am I getting this at discharge? I need this at admission, right? I need all this information at admission. And so we went back and we designed it from admission all the way through to discharge and continuing into the -discharge period. We did that with all comers and many of the results stayed the same, particularly the parenting self -advocacy piece.
Daphna Yasova Barbeau, MD (03:55.696)
Hmm... I think...
Craig Garfield (04:14.207)
The last study that we did with the third version was in more NICUs in the Chicago area. So in three additional NICUs. So now this is in four NICUs. And that had a much more diverse population of parents. Same idea of control and intervention groups. And what we found is that among one of the big findings really, in addition to the continued parenting self -efficacy, was that among black families who had the intervention,
their social support measures were higher than those of the control. And what we started to think about is that what's happening with technology, or it can happen with technology, and maybe it's why we all get excited about this in Tech Tuesdays and things like that, is that there is a pulling back of the curtain with NICU to Home. We give parents part of the features are a daily update so that we've kind of like condensed information for them and contextualize it into what happened for the last 24 hours for your baby. We give them
education written at a fifth and sixth grade level in their language that helps them understand what's going on. And it's not car seat test on day one for a 25 week or it's, like what is happening in this particular moment. And we're actually telling them who's on your team. Who was that wonderfully wonderful nurse and doctor who I can't remember their name because I've met 15 people today. We give them all of that information and it helps them understand it.
assimilate it and learn, not when they're sitting at the bedside with alarms going off and new admissions coming in, but actually when they can take in that new information. So that's really what we've been focusing on for NICU to home. And it's been a wonderful journey. And it's been great to kind of partner now with Angel Eye to get it out to more NICUs.
Ben Courchia MD (05:46.989)
Mm -hmm.
Daphna Yasova Barbeau, MD (05:59.152)
think what you said was so important because I think we're all facing this dilemma. We've got these acute patients, they're sick, then they're a little bit better. So we know we got a little bit time to maybe coast because they're just growing and they're developing and they're learning to eat. And then all of a sudden it's this frantic rush at discharge time. And I think that's what parents take home with them, even if we knocked the admission out of the park.
Craig Garfield (06:26.282)
Mm.
Daphna Yasova Barbeau, MD (06:28.888)
It's that frantic sensation at discharge that they remember the entire, they couch the whole admission in because that's their new reality, right? That's the whole rest of their lives. And so I really like this idea that a discharge begins at admission because that's really the goal is getting patients home safely.
Ben Courchia MD (06:29.636)
you
Craig Garfield (06:50.015)
Yeah. Yeah. I was just going to say I've never, I, I, I've never met someone who doesn't think we could do a better job with discharge. Right. Right. Yeah.
Daphna Yasova Barbeau, MD (06:57.04)
Right. That's right. That's right. I love that. And I appreciate you having given us so much feedback that you got from the kind of parent studies. I wonder what sort of feedback you're getting from like clinical staff. What do they like about the program? How has it helped their kind of day to day?
Ben Courchia MD (06:59.875)
But.
Craig Garfield (07:18.143)
Yeah, that's so important, right? So many things come into our units that we didn't really have much of a say on and suddenly we're doing things. We're like, wait, who agreed to that one? That's crazy. But you're like, okay, we'll do it because that's what we do, right? We're asked to do something. And I think, so yeah, I couldn't show my face on the unit if I designed something and we designed something that made it work harder and messed up the flow of things. So.
What happened with NICU to home was that we actually talked a lot to parents, a lot to parents. We talked a lot to bedside nurses. We talked to discharge coordinators when we had them. That's one of the interesting things about NICUs too is that sometimes you have them, sometimes you don't. Sometimes they're kind of the first thing to be cut off at the hospital. And I think we've cut them off, put them back in and cut them off again, at least twice in my 25 years. And then we talked with social workers.
And of course with physicians too to see kind of what makes sense like everything we did we did with a real intention towards not overwhelming anyone in NICU particularly parents but also staff and so we decided on about on a certain number of education pieces that get sent out every day to parents so they're not overwhelmed they come back and talk to staff about those pieces so one of my favorite examples is you know on day of life number two or three parents are coming in
And we're all worried, gosh, now we got to start to explain to them why the baby's under these blue lights and what does that mean and what is jaundice and everything. Parents walk in and nurse starts explaining to them and they're like, yeah, we got the education piece in the app that explained that the baby may be under lights and here's why. And they're totally not stressed, not worried, it's just kind of part of the flow of things. So what we hear from nurses is that they pretty much overwhelmingly feel that the parents who had the app
who were more informed in what was happening with their baby were more engaged. Their questions were better. The nurses reported having fewer phone calls into the NICU, which as a provider, feel like, but no, no phone calls is not good, but some phone calls are, but are they the right kind of phone calls? And what the staff told us was that the phone calls actually were just much more appropriate. And the parents were further along in the journey to discuss what was happening with their baby.
Daphna Yasova Barbeau, MD (09:22.042)
Right.
Daphna Yasova Barbeau, MD (09:30.811)
Hmm.
Craig Garfield (09:33.281)
And staff really loved it. They really loved it. And they knew that parents started, parents told us, like almost without exception, that they would start the day and they would end the day with the app, right? They would want it to see what happened in the morning. It allowed them to not have to call into the unit, which usually is around shift change. And then the nurse has to stop feeding one baby, kind of wash their hands, pick up the phone and.
Ben Courchia MD (09:37.442)
Mm -hmm.
Daphna Yasova Barbeau, MD (09:38.224)
That's great.
Daphna Yasova Barbeau, MD (09:46.63)
Hmm.
Craig Garfield (09:58.965)
So they just could quickly get a summary of what was happening. And then when their day as parents evolved a little bit better, maybe they got their kids out the door or got to work, whatever it was, they could check in with the NICU and see what was going on. Then at night what happened was that they would actually see who was taking care of my baby. And if it was someone who I knew who had been taking care of my baby for a month, it was a primary or whatever the unit had, then they'd be like, okay, I'm going to sleep well. And if it was someone new,
They'd say, you know, I want to talk to this person. They may not know how to feed my baby or like what my baby likes to do after they're fed or ways to kind of interact with them. And they just want to know who it was. So I think it worked its way. I think everyone's fear and it comes probably from the EMR rollouts is that this is going to make my life crazy. And we design it in a way that no one is doing any more additional charting. It's all part of your workflow. And we just use the benefits of technology to say, here's what we want to send to parents and how we want to help them understand what's happening with their baby.
Daphna Yasova Barbeau, MD (10:26.555)
Hehe.
Ben Courchia MD (10:34.039)
Mm.
Daphna Yasova Barbeau, MD (10:56.52)
I that. I just want to make sure we know about all of the features. So you've mentioned some of them. So it seems like there's kind of real time by post menstrual age education that goes out. That's kind of not specific necessarily to a baby. You've got this secure messaging that I think you can share that kind of personalized update. It sounds like you've got this
a dynamic roadmap feature that kind of is a visual guide that helps parents understand what those milestones to discharge look like, a set of surveys and educational resources. I don't know, maybe Nicole, if you want to tell us a little bit about what all of those features look like and if we missed any.
Nicole Nyberg (11:46.488)
Sure, I would love to. Yes, the dynamic roadmap, we, like Dr. Garfield said, we want to make sure that the parents have a very transparent view of what's going on with their baby. And we know all as providers, I am actually a NICU mom as well, that the first question that parents have is when is my baby able to go home? And unfortunately, we cannot pinpoint that to an exact date, but we want the family to be able to have a very visual view of where their baby is at and the progress. So obviously, you know, if you have a 23 -weeker,
they would know that they have some significant physiological milestones to complete before they would be able to go home. But as they continue to grow and progress, the family would be able to see that. Additionally, with that feature, it actually gives the family specific tasks for them to complete. So again, we're not waiting and focusing their education and what they need to know in those last 48 to 72 hours right before discharge. So the family can see.
tasks that they need to complete and whether that's reading an educational piece of material or bringing in the car seat or making the pediatrician appointment. So everybody, you know, can see what their role is. The surveys that you mentioned will help with addressing those social determinants of health and proactively trying to identify those needs for families.
as well as providers being able to keep a pinpoint on families and keep a pulse on what exactly is going on with them if they are doing okay. Even the Edinburgh Depression Scale can be sent out to families. Again, we just want to make sure that families are doing okay in the process because we do know how difficult an NICU admission is for families. The educational pieces that you mentioned, we tried to find educational material that was in languages beyond English and Spanish, and unfortunately there just are not any. So we at Angel Eye curated over, we have
over 800 pieces of content. A lot of the information is from what we're called Legacy NICU to Home that Dr. Garfield and his team took part in and wrote. And then we added some additional material through a multidisciplinary team. And this, all these pieces of information and content that are educational things, but also
Nicole Nyberg (13:48.344)
mental health support, psychological support, because again, just to help these families throughout the process, but they can be translated into over 70 languages. And as you mentioned, they can be, they will be synod automatically based on what's going on with the baby and their gestational age, and eventually even more specific to their medical diagnoses and what's going on with them. So the family truly has an idea of what's happening with their baby.
The daily updates Dr. Garfield mentioned again just gives the parents a very visual view of the previous 24 hours that their baby had and what they weigh and what know respiratory support they're on, how many stools they had, all those things that are incredibly important for families. And the secure messaging that you mentioned again is just a way to be able to connect with families. We can send photo, video, and text messages as well as the family can respond back to those And scheduling which allows our families to be able to identify when they're going to be coming in each day. And that way the care can be coordinated with the family so they can let the nurse know approximately when they'll be in, as well as tasks that they would like to do or different things they can do with their baby whenever they're at the bedside, whether it's skin to skin, they want to meet with lactation, if the mom's going to be bringing in fresh breast milk, just to help with that collaboration and coordination of care so that it can be aligned. And the family would identify that the day prior. So not just two hours ahead of time, but the day prior they would say, I'm planning to come tomorrow and these are the things that I would like to do.
Ben Courchia MD (15:36.58)
As we get close to the end of this episode, I wanted to highlight number one. think the premise of the NICU to Home app is such a good one. This idea of the time for discharge planning begins on admission is such an important one. And I've had so many attendings say those words on rounds. But the follow -up question, obviously, that lends itself to what you guys were describing is this sounds really cool. How do I...
use this? Like, so is it an app that I just download off the app store? Is it something that I sort of have to get customized for my unit? Do I have to work with the NICU to home team? Can you tell us a little bit about the process of getting these apps to the parents in the NICU? Or maybe can the parents download these already on their own? Like, can you tell us a little bit about the process from that step?
Nicole Nyberg (16:29.258)
Right. So the hospital where the patients are at, it would need to purchase NICU to home through AIM July. And so we will be officially launching NICU to home in early November. And we are working with hospitals now to try to get it in their hospital, whether it's through funding or what additional support so that because we want families to be able to utilize this, we know truly how beneficial it is. Just as Dr. Garfield in the mention, all of the benefits and the beginning of the show for families and ultimately
for our patients. And so we're working closely with hospitals because that's what will actually get it into a patient, you know, the families. And once they have the solution, then the family would be able to utilize it from their personal cell phone or computer.
Ben Courchia MD (17:04.844)
Mm -hmm.
Ben Courchia MD (17:13.71)
Got it, got it.
Craig Garfield (17:14.689)
One thing I'll just add to that too, just because people always have kind of like a love hate with the IT teams of, they can do wonderful things for us, but it has to happen when they can do it for us. It's not a very heavy lift on the tech side of things. It's connected by a fire API, which just is how all EMRs, regardless of which one you have, required to have this ability. So the tech piece is easy to set up. And to your point, Ben, about the content.
Well, Nicole mentioned we have over 800 pieces of content. There may be stuff that's special for your particular unit. Like you may have a music therapy or massage program or something that you want to include. So there's an opportunity to customize that also by each NICU because we know every NICU is a little bit different. We feel like we've covered the vast majority of things we want to make sure that every parent has access to. But there may be special things within your unit too.
Ben Courchia MD (17:53.208)
Mmm.
Ben Courchia MD (18:10.18)
Do you guys, last question for you obviously is that do you guys think since there's a tremendous amount of popularity for the Angel Eye camera system that's been rolling out throughout the country in the various NICUs, will units who are already working with Angel Eye on this one solution, will that create a little bit of a frictionless system to actually roll out this new solution, the NICU2 Home in these units? Or can you talk a little bit about that?
Nicole Nyberg (18:35.03)
That's a great question. actually, yes, if they already have cramped cameras, it is a fairly seamless integration to be able to add NICU to home into that because a lot of the groundwork has already been completed. So that is a great question. And yes, we whether there are hospitals that have currently have, you whether it's our cameras or a milk tracker or they do not have any of our solutions, just as Dr. Garfield said, to implement NICU to home in the hospitals is a fairly seamless process that we're excited to work with several hospitals to get it out there.
Ben Courchia MD (19:05.484)
Very nice. Again, thank you so much for making the time to be on with us to talk about NICU to home. I think you guys described pretty amazingly how this this tool is really meant to have a significant impact on families and their ability to cope and manage the complexities of both the NICU hospitalization and the NICU transition to home, but also does not neglect the NICU staff by providing so many resources and new tools to make
communication and workload so much more efficient with the families that we serve. So congratulations on that. And we will link all the various resources that we talked about, including actually Dr. Garfield, the papers that you mentioned where you did that randomized control trial on the episode show notes and some contact information for whoever is interested in getting in touch with your team. Thank you both again for your time today and congratulations on this amazing work.
Craig Garfield (20:02.101)
Thank you. Thanks for the time.
Nicole Nyberg (20:02.338)
Thank you so much.