A Decade of Evidence: The SIMPLE Program Shows Continued Success

A Decade of Evidence: The SIMPLE Program Shows Continued Success 1024 575 Pam Georgiana

In 2010, Nationwide Children’s Hospitals NICU leaders observed that infant feeding practices varied depending on the provider, resulting in significant variations in milestones and length of hospital stays (LOHS). They asked Sudarshan R. Jadcherla, MD, and Erika Osborn, NNP, to partner with stakeholders, including nurses, physicians, nutritionists, lactation experts, and others, to develop an evidence-based standardized feeding process. The goal was quality improvement through process optimization. The program experienced unparalleled support, from providers to leadership. “Everyone understood the importance of the project, all the way up to the chief medical officer and chief executive officer,” Dr. Jadcherla says.

They created and implemented the simplified, individualized, milestone-targeted, pragmatic, longitudinal, and educational (SIMPLE) feeding program.

“We trained over 300 nurses across the NICUs for the new program,” Dr. Jadcherla says.

The initiative focused on milestone targeted feeding interventions for each infant, considering their specific health needs and gestational age (GA). Ultimately, the SIMPLE feeding initiative aimed to improve outcomes and decrease length of stay for preterm infants in NICUs.

Initial data compared 92 baseline patients admitted before the SIMPLE program was implemented with 92 SIMPLE feeding program patients.[1] Despite similar clinical characteristics, feeding milestones and LOHS were significantly improved in the SIMPLE program patients.

“We cut down the average hospital stay by one month. We also improved oral feeding outcomes from 30% to 80%. Everyone — from parents to providers — was ecstatic with these results. The one team – one goal approach really worked,” Dr. Jadcherla says.

While the program has since become part of Nationwide’s standard procedures, variability in execution has occurred due to the large number of providers involved, employee turnover over time, the availability of new research, improved patient survival rates, and changes in policies at the national and institutional levels. Recently, the authors decided to analyze ten years of program data to measure the continued efficacy over time and develop predictive models for outcomes based on gestational age, feeding milestones and comorbidities.

“We wanted to see if the program’s implementation was long-lasting even with cultural change and practice variations,” Dr. Jadcherla says.

They studied the 434 preterm infants who participated in the SIMPLE program and found that more than 93% successfully reached full oral feedings.[2] They also noted that infants who achieved feeding milestones earlier were discharged earlier. Yearly analysis showed that acquisition of feeding milestones was consistently maintained or improved. The study also uncovered new data on micro-preemie babies born at less than 24 weeks GA. These babies were meeting critical milestones and their data will be used to develop new predictive models.

“Looking at babies individually and giving personalized care for those not meeting milestones has significantly improved outcomes and decreased length of stay in those outlier cases where extensive care is required,” Osborn explains.

Using this data, the authors developed prediction models for LOHS based on GA and other comorbidities like lung disease. As the SIMPLE program participants were limited to minimal comorbidities, more studies are needed for premature infants with complex and rare conditions with multiple comorbidities.

“We need to expand this work to address babies who have complex conditions, because expanding the SIMPLE program to include these babies may make a significant difference in their outcomes,” says Osborn.

“The SIMPLE program is cutting-edge and unique to Nationwide. We are the only program like it in the world, and our NICU outcomes reflect that,” Dr. Jadcherla says.

The authors hope that more hospitals will implement the SIMPLE program and its predictive models to dramatically improve patient outcomes and reduce long-term healthcare costs while improving quality of life.



[1] Jadcherla SR, Dail J, Malkar MB, McClead R, Kelleher K, Nelin L. Impact of process optimization and quality improvement measures on neonatal feeding outcomes at an all-referral neonatal intensive care unit. JPEN J Parenter Enter Nutr. 2016;40:646–55. doi: 10.1177/0148607115571667.

[2] Osborn EK, Alshaikh E, Nelin LD, Jadcherla SR. A decade of evidence: standardized feeding initiative targeting feeding milestones and predicting NICU stays in premature infants in an all-referral level IV NICU [published online ahead of print, 2023 Apr 29]. J Perinatol. 2023;1-8. doi:10.1038/s41372-023-01675-8

About the author

Pam Georgiana is a brand marketing professional and writer located in Bexley, Ohio. She believes that words bind us together as humans and that the best stories remind us of our humanity. She specialized in telling engaging stories for healthcare, B2B services, and nonprofits using classic storytelling techniques. Pam has earned an MBA in Marketing from Capital University in Columbus, Ohio.