Assessing the Influence of Shift Timing on Mortality Rates in <32-Week Preterm Infants.

Area of Science:

• Neonatology
• Pediatric Critical Care
• Healthcare Management

Background:

• Continuous patient care quality is vital in neonatal intensive care units (NICUs).
• Staffing levels and intervention timing can fluctuate with working hours, potentially influencing clinical outcomes.
• The impact of on-duty versus off-duty hours on neonatal mortality requires further investigation.

Purpose of the Study:

• To examine clinical data of deceased premature infants during on- and off-duty hours.
• To assess the frequency of neonatal mortality in relation to working hours.
• To determine if reduced physician presence during off-duty hours affects mortality and morbidity in premature infants.

Main Methods:

• Retrospective cohort analysis at a single institution.
• Inclusion of deceased infants born at or before 32 weeks' gestation (WG).
• Classification of patient deaths based on on-duty/off-duty periods and three 8-hour shifts.

Main Results:

• 256 deceased premature infants were analyzed; 66 (25.8%) during on-duty and 190 (74.2%) during off-duty hours.
• Off-duty periods were longer, yet mortality rates per unit time were comparable between on- and off-duty groups.
• Physician numbers decreased 4.5-fold during off-duty hours, but infant mortality and morbidity remained unchanged.

Conclusions:

• Reduced physician staffing during off-duty hours in the NICU did not correlate with increased mortality or morbidity for premature infants (≤32 WG).
• The study suggests that established protocols and team structures may mitigate risks associated with reduced on-site physician presence during off-duty periods.
• Further research could explore specific factors contributing to consistent outcomes across different staffing levels.