Neonatologist Workforce: Attending vs Primary Neonatologist Models 1060

Abstract

Number of Neos performing daytime rounds on a NICU baby over a hospital stay was assessed as part a workforce evaluation. Neo/NNP staffing 3 local Level III NICUs are based on the following: 1)Total Neos at each NICU are assigned to equalize workloads; 2)Neos provide continuity for care; 3)Neos average 1 day/week and every other weekend off; 4)No housestaff. NICU A (avg census 26; 6 Neos) uses a “primary” Neo model in which each baby has a primary Neo who rounds on them daily (except when off); when the primary Neo is off, a colleague covers. NICU B (avg census 42; 7 of 10 Neos staffing NICU BC 3 of 10 Neos) use an “attending” model with a Neo is responsible for a team of babies for 4 weeks; a backup “attending” covers days off. In NICU B daily there are 2 Neo and NICU C has 1 Neo (each with 1 backup). Neos rotate every 4 weeks. Methods: Prospectively daytime Neo were identified daily for each baby 11/1/96-11/6/97. Babies with LOS >2 days were analyzed (N=1585; 32,058 days). Results: Using >4 Neos as the negative outcome, Chi squared statistic was used to compare NICUs. Graph shows the percentage of babies cared for by >4 Neos at each NICU by LOS. Results: All babies with LOS>105 had >4 Neos (1.5% of babies). NICU C had fewer >4 Neo babies at LOS 4 Neo babies than NICU A until 71-105 LOS group (3.8% of babies), at which it was higher. Differences were significant at p<.001. Conclusion: The “primary” model exposed babies to more daytime Neos than the “attending” model. Figure