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Using the Neonatal Intensive Care Unit Wisely: A National Survey of Clinicians Regarding Practices for Lower-Acuity
John A F Zupancic1, Mark L Hudak2, Erika M Edwards3
1Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
Insights
Neonatal care providers often admit infants to higher levels of care than necessary and prefer shorter stays. Many clinicians believe current management for low-acuity newborns could occur in less intensive settings.
Area of Science:
- Neonatal Medicine
- Healthcare Practices
- Clinical Management
Background:
- Stakeholder practices and preferences for neonatal care location and duration for low-acuity newborns are not well-documented.
- Variability in care delivery can impact resource utilization and patient outcomes.
Purpose of the Study:
- To document the practices and preferences of neonatal care stakeholders regarding the location and duration of care for newborns with low illness acuity.
- To identify potential discrepancies between current practices and preferred management strategies.
Main Methods:
- A survey instrument with 14 questions was developed, covering global scenarios and specific clinical conditions (e.g., apnea of prematurity, jaundice, neonatal opioid withdrawal).
- The survey was administered to members of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine, the National Association of Neonatal Nurses, and the Vermont Oxford Network.
- Respondents reported current practices and preferences for alternative care approaches.
Main Results:
- 53% of 2284 respondents believed infants were admitted to a higher level of care than required.
- 46% perceived the length of stay as generally too long.
- Substantial variability in current practice was observed across 10 clinical questions, with up to 35% reporting discordance between current and preferred practice, favoring lower care levels in 8 scenarios.
Conclusions:
- US clinicians show significant variation in the level and duration of care for low-acuity infants.
- A majority of clinicians reporting practice-preference discordance believed current management could be provided in a lower level of care setting.
- Findings suggest potential for optimizing resource allocation and care pathways for non-critically ill newborns.
Objective:
The objective of this study was to document the practices and preferences of neonatal care stakeholders regarding location and duration of care for newborns with low illness acuity.
Study Design:
We developed a survey instrument that comprised 14 questions across 2 global scenarios and 7 specific clinical conditions. The latter included apnea of prematurity, gestational age for neonatal intensive care unit admission, jaundice, neonatal opioid withdrawal, thermoregulation, and sepsis evaluation. Respondents reported their current practice and preferences for an alternative approach. We administered the survey to individuals in the membership email distribution lists of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine, the National Association of Neonatal Nurses, and the Vermont Oxford Network.
Results:
Of 2284 respondents, 53% believed that infants were, in general, admitted to a higher level of care than was required, and only 13% reported that the level of care was too low. Length of stay was perceived to be generally too long by 46% of respondents and too short by 21%. Across 10 specific clinical questions, there was substantial variability in current practice and up to 35% of respondents reported discordance between current and preferred practice. These respondents preferred a lower level of care in 8 of 10 scenarios.
Conclusions:
A multidisciplinary sample of US clinicians reported significant variation in the level and duration of care for infants with low illness acuity. Among individuals reporting discordance between current and preferred practice, a majority believed that current management could be accomplished in a lower level of care location.
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