NEONATAL OUTCOME:ROLE OF CHANGE FROM AN ON-CALL TO IN-HOUSE COVERAGE MODEL. 906

Abstract

The standard model of physician staffing of neonatal care units (attending, resident, fellow) remains undefined. Recent changes in reimbursement and resident training have led to changes in NICU coverage. We postulated that in-house attending coverage in our NICU would improve patient outcome. We compared data from 1995 (control group with on-call coverage) to NICU data from 1996 (study group with in-house 24 hr coverage). Data from inborn NICU admissions were retrospectively collected and grouped by calendar year. There were no changes in nurse staffing, resident staffing, NICU attendings, delivery room policies or OB referral patterns during the years studied. Pediatric teams attended approximately the same number of deliveries in each group (46%). The infant populations were similar in number (total births and NICU admissions), birth weight and gestational age. The number of infants with 1 and 5 minute APGAR scores 1500 gm infants a similar reduction was noted; 53 in 1995 to 30 in 1996 and 7 in 1995 to 5 in 1996 for the 1 and 5 minute APGARs respectively. The use of CPR in the delivery room also showed a significant decline with the change in NICU coverage. In the 1500 gm birthweight. We conclude that the change from an on-call NICU attending coverage to an in-house attending coverage model appears to have resulted in a significant improvement in outcome.