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Dependency level of babies on the neonatal unit: a comparison of two different classification systems
C W Yoxall1, R W Cooke, N J Shaw
1Neonatal Intensive Care Unit, Liverpool Women's Hospital, Liverpool, UK. Bill.yoxall@lwh-tr.nwest.nhs.uk
Insights
Neonatal patient dependency levels are crucial for care planning. Two common systems show poor overall comparability, highlighting the need for standardized definitions for accurate quality assessment.
Area of Science:
- Neonatal care
- Healthcare management
- Quality improvement
Background:
- Monitoring neonatal unit activity is vital for service provision and quality assessment.
- Patient dependency levels, alongside patient numbers, are key considerations in neonatal care.
- Two primary systems are currently used to determine patient dependency levels in neonatal units.
Purpose of the Study:
- To develop a system for accurately determining neonatal patient dependency levels.
- To compare the British Association for Perinatal Medicine and Neonatal Nurses Association (BAPM/NNA) definitions with the Northern Neonatal Network (NNN) definitions.
- To assess the comparability of these two dependency assessment systems.
Main Methods:
- Collected daily data on clinical status and treatment for 1555 patients across two neonatal units over 17 months.
- Recorded 21,905 patient days in a computer database.
- Calculated patient dependency levels using both BAPM/NNA and NNN systems.
Main Results:
- While both systems agreed on the highest dependency levels, overall comparability was poor.
- Only 76% of patient days received comparable dependency level assignments between the two systems.
- Significant discrepancies exist in how the two systems categorize patient dependency.
Conclusions:
- Limited comparability exists between the widely used BAPM/NNA and NNN dependency level systems.
- Standardization of definitions is necessary for meaningful comparisons of care quality between neonatal units.
- Further research is needed to establish a unified approach to neonatal patient dependency assessment.
Background:
Monitoring activity on the neonatal unit is important for planning service provision and as part of monitoring quality of care. The dependency level of the patients cared for must be taken into account as well as the number of patients. Two different systems for determining dependency level are in common use.
Aim:
To develop a system that would allow the accurate determination of dependency level for babies in our care using both the British Association for Perinatal Medicine and Neonatal Nurses Association definitions and the Northern Neonatal Network definitions and to perform a comparison between these two systems.
Method:
Forty details relating to current clinical status and treatment being given were recorded daily for every patient on two neonatal units over a 17 month period. These details were recorded in a computer database, and dependency levels were calculated for each patient day using both systems.
Results:
A total of 21 905 patient days were recorded for 1555 patients. There was good agreement between the two systems on what constituted the highest level of dependency, but overall comparability was poor, with the two systems assigning comparable dependency levels to only 76% of patient days.
Conclusions:
There is limited comparability in dependency levels between these two widely used systems. There is a need for a standardisation of definitions to allow meaningful comparisons to be made between units.
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