1
|
Merlino Barr S, Hand RK, Fenton TR, Groh-Wargo S. Role of the neonatal registered dietitian nutritionist in Canada: A description of staffing and a comparison to practices in the United States. Nutr Clin Pract 2024; 39:1212-1226. [PMID: 39010702 DOI: 10.1002/ncp.11182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/15/2024] [Accepted: 06/07/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Neonatal registered dietitian nutritionists (RDNs) are critical members of the neonatal intensive care unit (NICU) team. Ideal RDN staffing levels are unknown. Current staffing levels of neonatal RDNs in Canadian NICUs have not been recently reported. The objective of this study was to describe neonatal RDN staffing and responsibilities in Canada and contrast these findings with those of neonatal RDNs in the United States. METHODS An online cross-sectional neonatal RDN survey was performed in the Fall of 2021 to collect hospital-level and individual-RDN-level data. Descriptive statistics were performed to summarize Canadian neonatal RDN staffing levels and responsibilities and compared with US findings. RESULTS Canadian RDNs reported a median staffing ratio of 25.3 NICU beds per RDN full-time equivalent, with neonatal RDNs reporting a desired 31% increase in staffing. The majority of Canadian NICUs (n = 20/24) reported having a dedicated space to prepare infant feeds away from bedside. Canadian neonatal RDNs reported wanting to expand their responsibilities in research, administration, and education. Canadian neonatal RDNs reported a higher rate of order writing privileges as compared with that of US neonatal RDNs. CONCLUSION Canadian neonatal RDNs reported a desired increase in their staffing levels. Neonatal RDNs have the potential to expand their professional role but require additional staffing, dedicated time, and compensation to support this. Further research determining the optimal neonatal RDN staffing ratio to maximize patient outcomes is required.
Collapse
Affiliation(s)
| | - Rosa K Hand
- Department of Nutrition, Case Western Reserve University, Cleveland, Ohio, USA
| | - Tanis R Fenton
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sharon Groh-Wargo
- Department of Pediatrics, MetroHealth Medical Center, Cleveland, Ohio, USA
- Department of Nutrition, Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
2
|
Thomas T, Heller G, Rolle U, Thome U. [Relationship between volume and structural characteristics and the quality of outcomes of perinatal centers for infants at the border of viability]. Z Geburtshilfe Neonatol 2024. [PMID: 39321986 DOI: 10.1055/a-2405-1233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
INTRODUCTION This study investigates the relationship between volume, structural characteristics and quality of outcome, specifically for infants at the border of viability. METHODS Using administrative data of the largest provider of statutory healthcare insurance in Germany between 2010-2015, infants with an admission weight (AW) between 250-1249 g treated initially in perinatal centers were included. For infants at the border of viability (250-499 g AW), the endpoints mortality and mortality or morbidity were analyzed. For comparison, infants with 500-749 g and 750-1249 g AW were analyzed. The impact of categorized volume (in quartiles) and structural characteristics (university hospital and in-house pediatric surgery) were examined in separate regressions. Odds ratios (ORs) and potentially avoidable deaths or severe morbidity were calculated. RESULTS Infants with 250-499 g AW were significantly more likely to survive if initially treated in perinatal centers with an estimated volume of 62 cases (250-1249 g AW) per year (OR: 0.43; 95%-CI: 0.20-0.96) or in university perinatal centers with in-house pediatric surgery (OR: 0.48; 95%-CI: 0.24-0.93). There was also a positive impact of volume and structural characteristics for infants with 500-749 g and 750-1249 g AW. CONCLUSION In addition to volume, structural characteristics also have a positive impact on the quality of outcomes. Additional requirements of structural characteristics for perinatal centers as well as a higher minimum volume may have a relevant positive impact on the outcome.
Collapse
Affiliation(s)
- Teresa Thomas
- Abteilung für Neonatologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Günther Heller
- Fakultät für Gesellschaftswissenschaften, Universität Duisburg-Essen, Duisburg, Germany
| | - Udo Rolle
- Klinik für Kinderchirurgie und Kinderurologie, Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Ulrich Thome
- Abteilung für Neonatologie, Universitätsklinikum Leipzig, Leipzig, Germany
| |
Collapse
|
3
|
Wu CL, Chen CH, Chang JH, Peng CC, Hsu CH, Lin CY, Jim WT, Chang HY. The effect of patient volume on mortality and morbidity of extremely low birth weight infants in Taiwan. J Formos Med Assoc 2023; 122:1199-1207. [PMID: 37286420 DOI: 10.1016/j.jfma.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 04/12/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND To assess whether the number of extremely low birth weight (ELBW) infants treated annually in neonatal intensive care units (NICUs) in Taiwan affects the mortality and morbidity of this patient population. METHODS This retrospective cohort study included preterm infants with ELBW (≤1000 g). NICUs were divided into three subgroups according to the annual admissions of ELBW infants (low, ≤10; medium, 11-25; and high, >25). Perinatal characteristics, mortality, and short-term morbidities were compared between groups. RESULTS A total of 1945 ELBW infants from 17 NICUs were analyzed (low-volume, n = 263; medium-volume, n = 420; and high-volume, n = 1262). After risk adjustments, infants from NICUs with low patient volumes were at a higher risk of death. The risk-adjusted odds ratios (aOR) for mortality were 0.61 (95% CI, 0.43-0.86) in the high-volume NICUs and 0.65 (95% CI, 0.43-0.98) in medium-volume NICUs, compared with infants admitted to low-volume NICUs. Infants in medium-volume NICUs had the lowest incidence of prenatal steroid exposure (58.1%, P < 0.001) and were associated with the highest risk of necrotizing enterocolitis (aOR, 2.35 [95% CI, 1.48-3.72]), severe intraventricular hemorrhage (aOR, 1.55 [95% CI, 1.01-2.28]), and bronchopulmonary dysplasia (aOR, 1.61 [95% CI, 1.10-2.35]). However, survival without major morbidity did not differ between the groups. CONCLUSION The mortality risk was higher among ELBW infants admitted to NICUs with a low annual patient volume. This may emphasize the importance of systematically referring patients from these vulnerable populations to appropriate care settings.
Collapse
Affiliation(s)
- Chia-Ling Wu
- Branch for Women and Children, Taipei City Hospital, Taipei, Taiwan; Department of Neonatology, MacKay Children's Hospital, Taipei, Taiwan
| | - Chia-Huei Chen
- Department of Neonatology, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Jui-Hsing Chang
- Department of Neonatology, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chun-Chih Peng
- Department of Neonatology, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chyong-Hsin Hsu
- Department of Neonatology, MacKay Children's Hospital, Taipei, Taiwan
| | - Chia-Ying Lin
- Department of Neonatology, MacKay Children's Hospital, Taipei, Taiwan
| | - Wai-Tim Jim
- Department of Neonatology, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Hung-Yang Chang
- Department of Neonatology, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
| |
Collapse
|
4
|
Tay CC, de la O S, Finn S, Fritzell J. More than Just a Fad: Building and Maintaining a Small Baby Program. Neonatal Netw 2021; 40:224-232. [PMID: 34330872 DOI: 10.1891/11-t-716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 11/25/2022]
Abstract
Survival rate for preterm infants has improved significantly in the last decade because of advancements in care provided by NICUs. Yet, a large proportion of extremely low birth weight (ELBW) infants continue to be at risk of being discharged home from NICUs with long-term co-morbidities. Several centers have introduced and described the concept of a focused program on the care of micro-preemies and demonstrated improved processes as well as outcomes utilizing a continuous improvement approach with adoption of standardized guidelines, checklists, and shared team values. The journey and effort that it takes to develop and sustain such a program have been described less. This article discusses the process of building a Small Baby Program using a change model framework, how the organization and staff bought into the concept, as well as the accomplishments and challenges experienced during the last 3 years as the program continues to evolve and grow.
Collapse
|
5
|
Mensen A, Roth B, Kuntz L, Wittland M, Glöckner V, Miedaner F. What matters most and for whom? A cross-sectional study exploring goals of health professionals in German neonatal intensive care units. BMJ Open 2021; 11:e044031. [PMID: 33753440 PMCID: PMC7986904 DOI: 10.1136/bmjopen-2020-044031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Quality of care largely depends on successful teamwork, which in turn needs effective communication between health professionals. To communicate successfully in a team, health professionals need to strive for the same goals. However, it has been left largely unaddressed which goals professionals consider to be important. In this study, we aim to identify these goals and analyse whether differences between (1) personal and organisational goals, (2) different professions and (3) hierarchical levels exist in neonatal intensive care units (NICUs). DESIGN Goals were identified based on a literature review and a workshop with health professionals and tested in a pilot study. Subsequently, in the main study, a cross-sectional employee survey was undertaken. SETTING AND PARTICIPANTS 1489 nurses and 537 physicians from 66 German NICUs completed the questionnaire regarding personal and organisational goal importance between May and July 2013. Answers were given based on a 7-point Likert scale varying between none and exceptionally high importance. RESULTS Results show that the goals can be subdivided into three main goal dimensions: patients, parents and staff. Furthermore, our results reveal significant differences between different professions and different hierarchical level: physicians rated patient goals with a mean (95% CI) importance of 6.37 (3.32 to 6.43), which is significantly higher than nurses with a mean (95% CI) importance of 6.15 (6.12 to 6.19) (p<0.01). Otherwise, nurses classified parental goals as more important (p<0.01). Furthermore, professionals in leading positions rate patient goals significantly higher than professionals that are not in leading positions (6.36 (3.28 to 6.44) vs 6.19 (6.15 to 6.22), p<0.01). CONCLUSIONS Different employee goals need to be considered in decision-making processes to enhance employee motivation and the effectiveness of teamwork. TRIAL REGISTRATION NUMBER DRKS00004589.
Collapse
Affiliation(s)
- Anne Mensen
- Department of Health Economics, RWI - Leibniz Institute for Economic Research, Essen, Germany
- Ruhr-University Bochum, Bochum, Germany
| | - Bernhard Roth
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University Hospital Cologne, Cologne, Germany
- Department of Business Administration and Healthcare Management, University of Cologne, Cologne, Germany
| | - Ludwig Kuntz
- Department of Business Administration and Healthcare Management, University of Cologne, Cologne, Germany
| | - Michael Wittland
- Department for Nursing and Health Care, Hannover University of Applied Sciences and Arts, Hannover, Germany
| | - Verena Glöckner
- Department of Business Administration and Healthcare Management, University of Cologne, Cologne, Germany
| | - Felix Miedaner
- Faculty of Public Health Services, Ostfalia University of Applied Sciences - Campus Wolfsburg, Wolfsburg, Germany
| |
Collapse
|
6
|
Heller G, Schnell R, Rossi R, Thomas T, Maier RF. [What is the Optimal Minimum Provider Volume in the Provision of Care for Preterm Infants with a Birth Weight below 1250 g in Germany?]. Z Geburtshilfe Neonatol 2020; 224:289-296. [PMID: 33075839 DOI: 10.1055/a-1259-2689] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Numerous studies have investigated volume-outcome relationships in the treatment of very low birth weight infants. However, studies addressing the identification of optimal thresholds when introducing minimum provider volumes for treatment of these infants do not exist. METHODS Publicly available data (www.perinatalzentren.org) of more than 56,000 infants weighing less than 1250 g at birth (NB<1250) and treated in level-1 perinatal centers (highest level in Germany) between 2010 and 2018 was used for statistical analysis. Potentially avoidable deaths after the introduction of minimum provider volumes were calculated by deducting observed deaths from estimated deaths based on logistic regression models for every existing empirical provider volume. Various smoothing functions were used to ascertain optimal thresholds for minimum provider volumes. RESULTS Independent of the observation period or smoothing technique, the highest number of potentially avoidable deaths was observed for minimum provider volumes of 50-60 NB<1250 per year. Introducing a minimum provider volume of 50 without a transition period would reduce the number of level-1 perinatal centers to a quarter of the current number in Germany. Approximately 60% of NB<1250 would have to be reallocated. CONCLUSION Analyses of resulting geographical distances are needed in the preparation of minimum provider volumes for treatment of NB<1250 in Germany. Such analyses should include perinatal centers expected to reach minimum provider volumes after subsequent reallocation in the future.
Collapse
Affiliation(s)
- Günther Heller
- Fachbereich Medizin, Philipps-Universität Marburg, Marburg
| | - Rainer Schnell
- Lehrstuhl für empirische Sozialforschung, Universität Duisburg-Essen, Duisburg
| | - Rainer Rossi
- Kinder- und Jugendmedizin - Perinatalzentrum, Vivantes Klinikum Neukölln, Berlin
| | - Teresa Thomas
- Abteilung für Neonatologie, Universitätsklinikum Leipzig, Leipzig
| | - Rolf F Maier
- Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Marburg, Philipps-Universität, Marburg
| |
Collapse
|
7
|
Jannes C, Miedaner F, Langhammer K, Enke C, Göpel W, Kribs A, Nitzsche A, Riedel R, Woopen C, Kuntz L, Roth B. Increased parental satisfaction by unrestricted visiting hours and developmentally supportive care in NICUs - results of a German multicenter study. J Matern Fetal Neonatal Med 2018; 33:1874-1880. [PMID: 32216530 DOI: 10.1080/14767058.2018.1532499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: This study aims to provide insights into the impact of organizational family-centered care characteristics at German neonatal intensive care units (NICUs) on the satisfaction of parents of very low birthweight (VLBW) infants.Materials and methods: Using multilevel modeling, this study analyzed whether organizational characteristics of NICUs fostering parent-infant interaction (by way of the existence of a recreation room, possibility of rooming in, existence of unrestricted visiting hours for parents, existence of parental classes, and the connection to parent associations as well as the existence of standards on developmentally supportive care) increase the satisfaction of parents after the infants' high-intensive care phase within the NICU.Results: Nine hundred and twenty-three VLBW infants from 66 NICUs in Germany born between May and October 2013 were enrolled in this multicenter study. We retrieved 1493 questionnaires completed by 1277 parents. The existence of unrestricted visiting hours (adjusted odds ratio (AOR): 1.967; 95% CI [1.118, 3.459]) and standardized procedures for developmentally supportive care (AOR: 1.775; 95% CI [1.166, 2.704]) were positively associated with parental satisfaction.Conclusions: Fostering the parent-infant interaction through the provision of developmentally supportive care and unrestricted visiting hours for parents whose infants are hospitalized within an NICU significantly contributes to the satisfaction of parents.
Collapse
Affiliation(s)
- Christiane Jannes
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne; and Research Unit Ethics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Felix Miedaner
- Department of Business Administration and Healthcare Management, University of Cologne, Cologne, Germany
| | - Kristina Langhammer
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University Clinic Cologne, Cologne, Germany
| | - Christian Enke
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne; and Research Unit Ethics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Wolfgang Göpel
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Angela Kribs
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University Clinic Cologne, Cologne, Germany
| | - Anika Nitzsche
- Faculty of Human Sciences and Faculty of Medicine, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Rainer Riedel
- Institute for Medical Economics and Health Services Research, Rheinische Fachhochschule Cologne, Cologne, Germany
| | - Christiane Woopen
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne; and Research Unit Ethics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Ludwig Kuntz
- Department of Business Administration and Healthcare Management, University of Cologne, Cologne, Germany
| | - Bernhard Roth
- Department of Business Administration and Healthcare Management, University of Cologne, Cologne, Germany.,Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University Clinic Cologne, Cologne, Germany
| |
Collapse
|