Presented at the Neonatal Society 2009 Autumn Meeting (programme).
Statnikov Y1, Santhakumaran S1, Manktelow B2, Modi N1 on behalf of the Neonatal Data Analysis Unit*
1 Section of Neonatal Medicine, Division of Medicine, Chelsea & Westminster campus, Imperial College London, London, UK
2 Department of Health Sciences, University of Leicester, Leicester, UK
Background: The Neonatal Data Analysis Unit (NDAU) utilises operational NHS electronic data captured at the point of care, to report on the activity of neonatal units and networks. A goal of managed networks is to concentrate intensive care in level 3 neonatal units through appropriate in-utero and post-natal transfers.
Aim: To evaluate the provision of intensive care by non-level 3 neonatal units in England.
Methods: The NDAU receives anonymised data with Caldicott Guardian approval. The dataset contains unit and network anonymised code, level designation and daily level of care(1). No patient identifiers are provided. Data presented here were collected from 1 January to 31 December 2008.
Results: Eighty-nine neonatal units (18 level one, 50 level two, 21 level three) from 17 networks in England contributed data. Across all 89 units, there were 48,457 intensive care days provided in 2008, representing 13.4% (48457/359693) of total care-days. For level 1, 2 and 3 neonatal units the proportion of intensive to total care days was 5% (2136/42973), 9% (18571/197679) and 23% (27550/119041) respectively. Of the total number of intensive care days, 42.7% (20707/48457) were provided by non-level 3 neonatal units. Data were also analysed for the 79 neonatal units that provided more than 1000 care days in 2008. The median, inter-quartile range and 10th/90th centiles for these units are shown figure 1. The inter-quartile range for proportion of intensive care days was 4.0%-5.3% for level one units, 6.1%-10.1% for level two units, and 21.8%-26.1% for level three units. The proportion of intensive care days exceeded 20% for 3 level 2 neonatal units.
Conclusion: These data do not represent all English neonatal units. However they indicate that though intensive care appears to represent a small proportion of the total care-days provided by the majority of non-level 3 neonatal units, these units deliver about two-fifths of the total intensive care work-load. Data such as these provide opportunity for objective review of workload and organisational arrangements by neonatal units and networks, particularly as participation in national analyses grows.
Acknowledgements: YS and SS are funded by NIHR programme grant, Medicine for Neonates;
*Members of the NDAU Steering Board: J Abbott (BLISS), P Brocklehurst, K Costeloe, E Draper, J Kemp, A Majeed, N Modi, A Wilkinson
References
1. BAPM, Standards for Hospitals Providing Neonatal Intensive and High Dependency Care (2nd edition), British Association of Perinatal Medicine, London 2001