Experience with implementation of a nurse practitioner-led newborn circumcision clinic.

Summary Introduction/background The Nurse Practitioner (NP)-Led Newborn Circumcision Clinic (NCC), developed in 2016, provides clamp-style circumcision to newborns without general anesthesia. There is a paucity of research regarding outcomes, satisfaction, and the cost benefit of such NP-led clinics. Objective The purpose of this descriptive study was to describe the impact of the NCC including family satisfaction, clinical and demographic characteristics, and cost. Study design This study utilized a mixed-method approach to describe the impact of the NP-led NCC using survey methodology to describe family satisfaction, a single center retrospective chart review to describe clinical and demographic characteristics and outcomes, and investigation of charges in NCC versus operating room (OR) circumcisions. Descriptive statistics were used to present survey results and chart review data. Results Results of the patient satisfaction survey revealed 89.8% of patients rated the overall quality of care as excellent or very good. Of the 234 patients reviewed, the median age and weight of patients was 4.30 weeks and 4.39 kg, respectively. Of the patients with comorbidities (30.3%), the most common were related to prematurity (12.8%). The most common reason for referral was concern for anatomical abnormality of the penis (53.8%). The median length of procedure was 20 minutes. No patients in our cohort experienced penile amputations, infections, strictures, intraoperative bleeding, or wounds. Ten patients (4.3%) had bleeding events during the recovery period which were treated with a topical medication (StatSeal). Two patients (0.9%) had bleeding after discharge requiring Emergency Department evaluation and application of a pressure dressing. Two patients (0.9%) required circumcision revision. Investigation of charges revealed a savings of 92.9% for circumcisions in the NCC versus OR. Discussion This study reveals that the NP-led NCC has high family satisfaction, few adverse outcomes, and cost benefits as compared to OR circumcision. There are a limited number of publications presenting outcome data for circumcisions and even fewer for NP- led circumcision clinics. Furthermore, a lack of standardized definitions for adverse events makes comparison difficult. Conclusions Critical to the success of the NP-led NCC is appropriately selecting patients, a NP training program, and intra-professional collaboration. This ambulatory clinic offers another option for select infants who were not immediately circumcised in the newborn period. By expanding opportunities for NPs to practice to the full extent of their education and expertise, our institution continues to develop opportunities to improve access to care, control costs, and increase patient and family satisfaction. Summary Table . NP-led Newborn Circumcision Clinic Clinical Outcomes NCC Clinical Outcomes Median [IQR]/n (%) During Circumcision Procedure N = 234 Length of Procedure Events that Occurred 20.00 min [13.00 - 28.00] Sutures by MD for Skin Separation 2 (0.9) None 232 (99.1) During Recovery Length of Recovery Events that Occurred 60.00 min [60.00 - 60.00] Bleeding Treated by StatSeal Topically 10 (4.3) None 224 (95.7) Post-procedural Day 0 to Day 6 Events that Occurred Unplanned Emergency Department Visit for Bleeding 2 (0.9) Treated with Pressure Dressing 2 (100) None 232 (99.1) Follow-up Visit: Post-procedural Day 7 N = 228 Events that Occurred Adhesions 10 (4.4) Treated with Betamethasone Topically 9 (90.0) Noted without Treatment 1 (10.0) None 218 (95.6) After Follow-up Visit Unplanned Clinic Visit Adhesions 7 (3.1) Treated with Betamethasone Topically 2 (28.6) In-Office Lysis of Adhesions 5 (71.4) Parental Concern/Normal Anatomy 1 (0.4) Cicatrix Treated with Betamethasone 2 (0.9) Circumcision Revision 2 (0.9)