Kerri Z Machut1, Ankur Datta2, Jason Z Stoller3, Rakesh Rao4, Amit Mathur4, Theresa R Grover5, Zeenia Billimoria6, Karna Murthy7. 1. Feinberg School of Medicine, Northwestern University and Ann Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. Electronic address: k-machut@northwestern.edu. 2. Feinberg School of Medicine, Northwestern University and Ann Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI. 3. Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, PA. 4. Washington University School of Medicine and St Louis Children's Hospital, St. Louis, MO. 5. University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Children's Hospitals Neonatal Consortium, Kansas City, MO. 6. University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA. 7. Feinberg School of Medicine, Northwestern University and Ann Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Children's Hospitals Neonatal Consortium, Kansas City, MO.
Abstract
OBJECTIVES: To describe neonatologist continuity of care and estimate the association between these transitions and selected patient outcomes. STUDY DESIGN: We linked Children's Hospitals Neonatal Database records with masked neonatologist daily schedules at 4 centers, which use 2- and 3-week and 1-month "on service" blocks to provide care. After describing the neonatologist transitions, we estimated associations between these transitions and selected short-term patient outcomes using multivariable Poisson, logistic, and linear regression analyses, independent of length of stay (LOS) and case-mix. We also completed analyses after stratifying the cohort by LOS, birthweight, age at admission categories, and selected diagnoses. RESULTS: Stratified by LOS, patient transitions varied between centers in both unadjusted (P < .001) and multivariable analyses (adjusted incidence rate ratio; 95% CI for center B = 3.98 (3.81-4.15), center C = 4.92 (4.71-5.13), center D = 4.2 (4.0-4.4), P < .001), independent of LOS, gestational age, birthweight, surgical intervention, ventilator duration, and mortality. Only central venous line duration (adjusted incidence rate ratio 1.015, 95% CI 1.01-1.02) was minimally and independently associated with the number of transitions. No differences were observed in ventilator duration, oxygen use at neonatal intensive care unit discharge, bloodstream infections, or urinary tract infections. Surviving infants with meconium aspiration, hypoxic ischemic encephalopathy, cerebral infarction, bronchopulmonary dysplasia, and diaphragmatic hernia demonstrated similar findings. CONCLUSIONS: Transitions in neonatologists are frequent in regional neonatal intensive care units but appear unrelated to short-term patient outcomes. Future work to define continuity of care and develop effective strategies that promote longitudinal inpatient management is needed.
OBJECTIVES: To describe neonatologist continuity of care and estimate the association between these transitions and selected patient outcomes. STUDY DESIGN: We linked Children's Hospitals Neonatal Database records with masked neonatologist daily schedules at 4 centers, which use 2- and 3-week and 1-month "on service" blocks to provide care. After describing the neonatologist transitions, we estimated associations between these transitions and selected short-term patient outcomes using multivariable Poisson, logistic, and linear regression analyses, independent of length of stay (LOS) and case-mix. We also completed analyses after stratifying the cohort by LOS, birthweight, age at admission categories, and selected diagnoses. RESULTS: Stratified by LOS, patient transitions varied between centers in both unadjusted (P < .001) and multivariable analyses (adjusted incidence rate ratio; 95% CI for center B = 3.98 (3.81-4.15), center C = 4.92 (4.71-5.13), center D = 4.2 (4.0-4.4), P < .001), independent of LOS, gestational age, birthweight, surgical intervention, ventilator duration, and mortality. Only central venous line duration (adjusted incidence rate ratio 1.015, 95% CI 1.01-1.02) was minimally and independently associated with the number of transitions. No differences were observed in ventilator duration, oxygen use at neonatal intensive care unit discharge, bloodstream infections, or urinary tract infections. Surviving infants with meconium aspiration, hypoxic ischemic encephalopathy, cerebral infarction, bronchopulmonary dysplasia, and diaphragmatic hernia demonstrated similar findings. CONCLUSIONS: Transitions in neonatologists are frequent in regional neonatal intensive care units but appear unrelated to short-term patient outcomes. Future work to define continuity of care and develop effective strategies that promote longitudinal inpatient management is needed.
Authors: Heather C Kaplan; Erika M Edwards; Roger F Soll; Kate A Morrow; Jeffrey Meyers; Wendy Timpson; Howard Cohen; Marybeth Fry; Elizabeth Schierholz; Madge E Buus-Frank; Jeffrey D Horbar Journal: J Perinatol Date: 2020-07-14 Impact factor: 2.521