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]
Summary
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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