Presented at the Neonatal Society 2008 Spring Meeting.
Asaduzzaman MD1, Chaussalet TJ1, Hawdon J2,3, Wood D2, Robertson NJ2,3
1 Health and Social Care Modelling Group, School of Informatics, University of Westminster, UK
2 North Central London Perinatal Network Board, University College London NHS Trust, UK
3 EGA UCL Institute for Women’s Health, University College London, UK
Background: Managed clinical networks for neonatal care were established in 2004 (Marlow and Gill 2007) with the long term goal to achieve an appropriate level of care in the right place. One of the aims was that neonates < 27 weeks gestational age should be cared for in a perinatal network centre; cot shortages however occur and this goal is at times difficult to achieve. Rigorous mathematical modelling approaches have been applied to assist in capacity planning in other clinical specialties (Litvak et al 2008).
Objective: 1. To study the pattern of arrivals and length of stay in the neonatal intensive care / high dependency unit (NICU) and special care baby unit (SCBU) in a perinatal network centre 2. To determine the infant factors associated with capacity shortage 3. To provide objective baseline information for improving capacity planning
Methodology: The data used for this study had been collected through the South England Neonatal Database (SEND) and the North Central London Perinatal Network Transfer Audit between 1 January and 31 December 2006 for neonates admitted to the neonatal unit at University College London Hospital (UCLH), the North Central London Perinatal Centre. Agreement from the Caldicott Guardian was obtained and the data were anonymised. Exploratory data analysis was performed. Neonates were stratified according to length of stay, birth weight and gestational age. A queuing model was used to study the influence of cot capacity, admissions, and length of stay on admission refusal.
Outcome measures: Admission pattern; length of stay; predicted number of cots required with existing arrival and discharge patterns.
Results: In 2006, 1002 neonates were admitted to the neonatal unit at UCLH. The unit has 12 NICU funded cots, 15 SCBU funded cots, and 8 transitional care cots. Thirty-one percent were admitted to NICU and the remaining to SCBU. Of the NICU admissions 18.7% were < 27 weeks gestational age. In SCBU, cot occupancy was above capacity throughout the year. In NICU, two peaks in cot occupancy were observed in the spring (weeks 14-28) and the autumn (weeks 39-48) (Fig 1). Although the number of admissions did not exhibit this seasonal pattern, length of stay was higher for those admitted during spring and autumn (Fig 2). Cluster analysis indicated that neonates with a gestational age < 27 weeks have longer NICU stays.
Conclusion: This study highlighted some of the major issues of capacity planning of a perinatal centre. The arrival, length of stay and discharge of neonates having gestational age < 27 weeks were the key determinants of cot occupancy and capacity for new admissions. The queuing model can be used to determine the cot capacity required for a given level of admission refusal.
References
1. Marlow, N. and Gill, A.B.(2007). Establishing neonatal networks: the reality, Arch. Dis. Child. Fetal Neonatal Ed., 92(2):F137-42.
2. LLitvak, N., Rijsbergen, M.V., Boucherie, R.J. and Houdenhoven, M.V.(2008). Managing overflow of intensive care patients, European Journal of Operational Research, 185(3):998-1010.