Housestaff workload and procedure frequency in the neonatal intensive careunit

Citation
Ch. Griffith et al., Housestaff workload and procedure frequency in the neonatal intensive careunit, CRIT CARE M, 27(4), 1999, pp. 815-820
Citations number
8
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Aneshtesia & Intensive Care
Journal title
CRITICAL CARE MEDICINE
ISSN journal
0090-3493 → ACNP
Volume
27
Issue
4
Year of publication
1999
Pages
815 - 820
Database
ISI
SICI code
0090-3493(199904)27:4<815:HWAPFI>2.0.ZU;2-7
Abstract
Objective: To investigate the association of clinical workload and the deci sion to perform procedures on infants in the neonatal intensive care unit ( NICU), Design: Prospective cohort study over one academic year, observing infants exposed to housestaff working under various levels of clinical workload. Subjects: All 31 housestaff rotating on the NICU service during the academi c year 1993 to 1994 were observed. A total of 785 infants were admitted to these housestaff. Setting: One academic Level III intensive care nursery. Measurements and Main Results: Clinical workload was operationalized as num ber of NICU infants cared for by the individual houseofficer on call each n ight. The procedures of interest were number of umbilical artery catheters (UACs), intubations, lumbar punctures (LPs), and peripheral phlebotomy perf ormed by the houseofficer on-call. Using multiple linear regression approac hes, controlling for the average severity of-illness of each of the NICU in fants, the experience and residency program of the houseofficer on call, an d the individual attending, we found that increased clinical workload (numb er of NICU infants) resulted in a significantly greater probability that an admitted infant received an umbilical artery catheter (p =.02), but result ed in less probability that any NICU infant received a lumbar puncture (p = .0001) or peripheral phlebotomy (p =.0002). The decision to intubate an inf ant was not affected by the workload in the NICU. Conclusions: The clinical workload of housestaff in the NICU can affect dec isions to perform procedures on infants in the NICU. For equivalently sever ely ill infants, there is a greater chance of receiving a UAC and less chan ce of being phlebotomized or receiving an LP when workload is high. Attendi ng neonatologists need to be sensitive to possible effects of workload on p atient care in the NICU.