Analysis of newborn intensive care by time-lapse photography

The activities of nurses, residents, and fellows providing newborn intensive care were studied by time-lapse photography. Six of 40 frames taken each hour during a 23-day period were evaluated. Time spent in bedside care, charting, handwashing, and other activities were estimated for personnel in a four-bed area. The amount of care prescribed for each infant was assessed independently by calculation of a care score from the physicians' orders. Physician activities were significantly diminished at night and on weekends. Bedside care given by physicians increased abruptly at high care scores. Total bedside nursing care was unaffected by time-related variables (day vs. night; weekday vs. weekend; nursing rotations). Regression analysis showed a linear two- to three-fold increase in bedside nursing time with increasing care score. Individual nurses differed significantly in mean time devoted to bedside care and in their response to increasing infant care score. Differences between nurses accounted for as much of the total variation in bedside care (30%) as did differences between infants in care needs. Many factors are likely to affect the individual or group performance of nursery staff. The traditional duty schedule for physicians is associated with a deterioration in their performance at night and the nocturnal increase in neonatal acidosis and mortality previously reported by the authors.