Dependency level of babies on the neonatal unit: a comparison of two different classification systems

• Published in: Archives of disease in childhood. Fetal and neonatal edition Vol. 85; no. 3; pp. F173 - F176
• Main Authors: Yoxall, C W, Cooke, R W I, Shaw, N J, Subhedar, N V, Weindling, A M
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01.11.2001; BMJ; BMJ Publishing Group Ltd; BMJ Publishing Group LTD; National Library of Medicine - MEDLINE Abstracts; BMJ Group
• Subjects: Algorithms; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Babies; Biological and medical sciences; Classification; Databases, Factual; Datasets; dependency; Emergency and intensive care: neonates and children. Prematurity. Sudden death; England; Evaluation; Hospital care; Hospitals; Humans; Infant, Newborn; Infants (Newborn); Intensive care; Intensive care medicine; Intensive Care Units, Neonatal - organization & administration; Intensive Care Units, Neonatal - statistics & numerical data; Medical care; Medical sciences; Needs Assessment - classification; Neonatal nursing; neonatal units; Neonatology; Nursing; Original; Ostomy; Patients; Prospective Studies; quality of care; Reproducibility of Results; Respiratory diseases; service provision; Severity of Illness Index; United Kingdom; Utilization Review - methods; Ventilation; United Kingdom; Human; Evaluation; Newborn; Classification; Dependence; Resuscitation; Care; System
• ISSN: 1359-2998; 1468-2052
• DOI: 10.1136/fn.85.3.F173

BACKGROUND Monitoring activity on the neonatal unit is important for planning service provision and as part of monitoring quality of care. The dependency level of the patients cared for must be taken into account as well as the number of patients. Two different systems for determining dependency level are in common use. AIM To develop a system that would allow the accurate determination of dependency level for babies in our care using both the British Association for Perinatal Medicine and Neonatal Nurses Association definitions and the Northern Neonatal Network definitions and to perform a comparison between these two systems. METHOD Forty details relating to current clinical status and treatment being given were recorded daily for every patient on two neonatal units over a 17 month period. These details were recorded in a computer database, and dependency levels were calculated for each patient day using both systems. RESULTS A total of 21 905 patient days were recorded for 1555 patients. There was good agreement between the two systems on what constituted the highest level of dependency, but overall comparability was poor, with the two systems assigning comparable dependency levels to only 76% of patient days. CONCLUSIONS There is limited comparability in dependency levels between these two widely used systems. There is a need for a standardisation of definitions to allow meaningful comparisons to be made between units.