Improving compliance with safe sleep practices among Black/African American infants discharged from a level III NICU: a quality improvement initiative.

INTRODUCTION: Sudden unexpected infant death (SUID) remains a leading cause of infant mortality in the USA, disproportionately affecting Black/African American infants. In Cook County, Illinois, Black/African American infants had SUID rates 14 times higher than non-Hispanic white infants between 2020 and 2021. Despite widespread safe sleep education, racial disparities persist. Our Specific, Measurable, Acheivable, Relevant, and Time-Bound (SMART) aim was to increase safe sleep compliance among mothers of Black/African American infants discharged from our neonatal intensive care unit (NICU) by 5% over 12 months by providing targeted, equitable and culturally sensitive education, measured using an adapted validated safe sleep survey. METHODS: This project, conducted in a level III NICU at the University of Illinois Hospital in Chicago began planning in May 2023. Baseline data were collected (November 2023-February 2024) via caregiver surveys and chart reviews. Plan-Do-Study-Act (PDSA) cycles (March-November 2024) introduced interventions like the 'Alone-Back-Crib' (ABC) Safe Sleep handouts on SUID disparities, staff education, and short videos. Compliance was assessed postdischarge through surveys and clinic questionnaires, with preintervention and postintervention data analysed using χ² and t-tests. A control chart (p-chart) tracked process changes. RESULTS: Among 248 infants (70 baseline, 178 intervention), mean safe sleep compliance increased from 96% to 97% (p=0.26). Reports of infants 'never' sleeping alone in a crib declined from 11.4% to 3.9% (p=0.01). Caregivers valued enhanced messaging on SUID disparities. CONCLUSIONS: Despite high baseline compliance, culturally tailored education reinforced safe sleep practices. While overall adherence changed minimally, increased awareness and behavioural shifts highlight the need for sustained interventions, community engagement, implicit bias training and systemic strategies to reduce racial disparities in SUID.