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Housestaff experience, workload, and test ordering in a neonatal intensive care unit
C H Griffith1, N S Desai, J F Wilson
1Division of General Internal Medicine, University of Kentucky College of Medicine, Lexington 40536-0284, USA.
Summary
In the neonatal intensive care unit (NICU), interns order more arterial blood gas (ABG) tests per infant than residents when the clinical workload is high. This difference is more pronounced during less supervised periods, such as weekends.
Area of Science:
- Neonatal Intensive Care Unit (NICU) Medicine
- Medical Education
- Healthcare Management
Background:
- Limited understanding of how housestaff inexperience and clinical workload influence decision-making in the NICU.
- Hypothesis: Less experienced interns order more tests than residents, particularly under heavy workload conditions.
Purpose of the Study:
- To compare test ordering patterns between interns and residents in a NICU setting.
- To investigate the impact of clinical workload on test ordering by housestaff.
Main Methods:
- Observational study comparing test orders (X-rays, ABGs, electrolytes) by on-call interns and residents over five months.
- Multivariate linear regression analysis used to compare data from 321 infants and nine interns versus seven residents.
Main Results:
- Interns significantly increased ordering of arterial blood gases (ABGs) per infant as workload increased (approx. five NICU patients).
- This increase in ABG ordering by interns was more pronounced during weekends, indicating a greater effect under less supervision (p = .004).
Conclusions:
- Increased clinical workload in the NICU leads to higher rates of ABG ordering by interns compared to residents.
- Reduced supervision, especially on weekends, exacerbates the tendency for interns to order more tests under heavy workload.