Abstract

Objective:To examine burnout prevalence among California neonatal intensive care units (NICUs) and to test the relation between burnout and healthcare-associated infection (HAI) rates in very low birth weight (VLBW) neonates.Study Design:Retrospective observational study of provider perceptions of burnout from 2073 nurse practitioners, physicians, registered nurses and respiratory therapists, using a validated four-item questionnaire based on the Maslach Burnout Inventory. The relation between burnout and HAI rates among VLBW (<1500 g) neonates from each NICU was evaluated using multi-level logistic regression analysis with patient-level factors as fixed effects.Results:We found variable prevalence of burnout across the NICUs surveyed (mean 25.2±10.1%). Healthcare-associated infection rates were 8.3±5.1% during the study period. Highest burnout prevalence was found among nurses, nurse practitioners and respiratory therapists (non-physicians, 28±11% vs 17±19% physicians), day shift workers (30±3% vs 25±4% night shift) and workers with 5 or more years of service (29±2% vs 16±6% in fewer than 3 years group). Overall burnout rates showed no correlation with risk-adjusted rates of HAIs (r=−0.133). Item-level analysis showed positive association between HAIs and perceptions of working too hard (odds ratio 1.15, 95% confidence interval 1.04–1.28). Sensitivity analysis of high-volume NICUs suggested a moderate correlation between burnout prevalence and HAIs (r=0.34).Conclusion:Burnout is most prevalent among non-physicians, daytime workers and experienced workers. Perceptions of working too hard associate with increased HAIs in this cohort of VLBW infants, but overall burnout prevalence is not predictive.

Highlights

  • In 1999, the Institute of Medicine estimated that medical errors are responsible for up to 98 000 deaths annually in the United States of America.[1]

  • We offered to analyze and provide feedback on a survey of safety culture and workforce engagement to all 61 neonatal intensive care units (NICUs) who participated in the improvement initiative, 44 of which accepted

  • We adjusted infection rates according to a severity of illness model we developed in a previous study.[29]

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Summary

Introduction

Very low birth weight (VLBW) infants are vulnerable to errors, and adverse events occur with up to 10-fold variation among neonatal intensive care units (NICUs).[4]. Neonatal infections are especially hazardous, with sequelae including prolonged length of stay,[5] adverse neurodevelopmental outcomes[6] and increased mortality.[5,7,8] Higher infection rates have been linked to poor performance in other areas of safety culture including teamwork and safety climate,[9,10] raising concern for burnout as a source of decreased quality of healthcare,[11,12] in relation to critically ill pediatric patients

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