Introduction of 24 h Resident Consultant Cover in a Tertiary Neonatal Unit-Impact on Mortality and Clinical Outcomes.

Carolina Zorro,Anne Greenough,Anusha Arasu,Theodore Dassios,Ann Hickey,Ravindra Bhat

doi:10.3390/children8100865

Abstract

Background: We aimed to determine whether the introduction of 24 h cover by resident consultants in a tertiary neonatal unit affected mortality and other clinical outcomes. Methods: Retrospective cohort study in a tertiary medical and surgical neonatal unit between 2010–2020 of all liveborn infants admitted to the neonatal unit. Out of hours cover was rearranged in 2014 to ensure 24 h presence of a senior trained neonatologist (resident consultant). Results: In the study period, 4778 infants were included: 2613 in the pre-resident period and 2165 in the resident period. The median (IQR) time to first consultation by a senior member of staff was significantly longer in the pre-resident period [1.5 (0.6–4.3) h] compared to the resident period [0.5 (0.3–1.5) h, p < 0.001]. Overall, mortality was similar in the pre-resident and the resident periods (3.2% versus 2.3%, p = 0.077), but the mortality of infants born at night was significantly higher in the pre-resident (4.5%) compared to the resident period (2.5%, p = 0.016). The resident period was independently associated with an increased survival to discharge (adjusted p < 0.001, odds ratio: 2.0) after adjusting for gestational age, admission temperature and duration of ventilation. Conclusions: Following introduction of a resident consultant model the mortality and time to consultation after admission decreased.

Highlights

Introduction of24 h Resident Consultant Cover in a TertiaryNeonatal Unit—Impact on Mortality and Clinical OutcomesCarolina Zorro 1, Theodore Dassios 1,2, *, Ann Hickey 1, Anusha Arasu 1, Ravindra Bhat 1 and Anne Greenough 2,3,4 *Citation: Zorro, C.; Dassios, T.; Hickey, A.; Arasu, A.; Bhat, R.; Greenough, A
Adverse neonatal outcomes are associated with increased mortality and long term disability [1]
A total of 6867 infants were admitted to the Neonatal Intensive Care Centre at King’s College Hospital (KCH) in the study period

Summary

Introduction

Introduction of24 h Resident Consultant Cover in a TertiaryNeonatal Unit—Impact on Mortality and Clinical OutcomesCarolina Zorro 1 , Theodore Dassios 1,2, *, Ann Hickey 1 , Anusha Arasu 1 , Ravindra Bhat 1 and Anne Greenough 2,3,4 *. Resident Consultant Cover in a Tertiary Neonatal Unit—Impact on Mortality and Clinical Outcomes. The traditional model of neonatal care in the United Kingdom consisted of resident consultant clinical cover during standard working hours (8 am to 5 pm) with the on-call consultant covering the service from home during late evening and at night. In a 24 h consultant-led service though, the consultant is clinically responsible for patient care and will provide either hands-on care or closely supervise in the clinical setting all aspects of care This model of care requires a consultant to be present in the hospital outside normal working hours and the term ‘resident consultant’ refers to physicians working within this model most typically on shift patterns [3]. We aimed to determine whether the introduction of 24 h cover by resident consultants in a tertiary neonatal unit affected mortality and other clinical outcomes. Conclusions: Following introduction of a resident consultant model the mortality and time to consultation after admission decreased

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