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Back transfer: capability of community hospitals to serve chronically ill and convalescing infants
A Farel1, M Kotelchuck, K Metzguer
1Department of Maternal and Child Health, University of North Carolina, Chapel Hill 27599-7400.
Insights
Intermediate hospitals can care for many back-transferred infants, but nursing staff shortages limit capacity. This impacts discharge planning for neonatal intensive care units.
Area of Science:
- Neonatal care
- Healthcare systems research
- Pediatric medicine
Background:
- Neonatal intensive care unit (NICU) crowding compromises care for critically ill newborns.
- Transferring stable infants to community hospitals can alleviate NICU overcrowding.
- Intermediate-level community hospitals' capacity for such transfers is not well-defined.
Purpose of the Study:
- To evaluate the readiness of North Carolina's intermediate-level community hospitals to accept back-transferred infants from NICUs.
- To identify resources and limitations affecting the care of these infants in community settings.
Main Methods:
- A telephone survey was conducted with 35 intermediate-level community hospitals in North Carolina with >= 600 annual births.
- Hospital resources and equipment were assessed.
- A 3-month census tracked daily nursery populations, including back-transferred infants.
Main Results:
- Intermediate hospitals had a mean daily census of 288 infants.
- Back-transferred infants and those with stays >5 days comprised 24% of the nursery population.
- 80% of hospitals possessed the equipment and medical directors to manage common back-transfer cases, but nursing staff shortages were a significant barrier.
Conclusions:
- Intermediate community hospitals in North Carolina possess considerable resources for caring for back-transferred infants.
- Shortages of appropriately trained nursing staff represent the primary obstacle to implementing effective back-transfer programs.
- These findings highlight the need for improved discharge planning and community-based care systems for neonatal populations.
Abstract:
Severe crowding in neonatal intensive care facilities may prevent many critically ill newborn infants from receiving optimal care. Crowding could be alleviated by back transferring chronically ill or convalescing infants to intermediate-level community hospitals where community-based care can be delivered. The purpose of this study was to assess the ability of such hospitals in North Carolina to care for these children. A telephone survey was administered to all 35 intermediate-level community hospitals that had > or = 600 births per year. Hospital resources were assessed on the first call, and a 1-day census was taken for three successive months. Total daily nursery census was 288. Back-transferred infants (32) and infants whose stay exceeded 5 days (32) constituted 24% of the nursery population. Each hospital had a pediatric medical director and necessary equipment to care for back transfers, and 80% of the hospitals could accept a back-transferred infant who was in a neonatal incubator, tube fed, receiving oxygen, 1400 gm, with mild and infrequent apnea and bradycardia--a common clinical picture in such infants. The most severe limitation to accepting infants for back transfer was the shortage of nursing staff appropriately trained to care for this population. These data have implications for effective discharge planning and the development of appropriate community-based, service-delivery systems.