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Fullness of the neonatal intensive care unit influences early discharge of moderately preterm infants

Decisions about discharging moderately preterm infants from hospital neonatal intensive care units (NICUs) are based partly on how crowded the NICU is, according to a new study supported by the Agency for Healthcare Research and Quality (T32 HS00063 and HS10131). A moderately preterm infant was 20 percent less likely to be discharged than expected when the NICU census was very low and 32 percent more likely to be discharged than expected when the NICU census was high. Infants with prolonged lengths of stay, minor congenital anomalies, and a higher SNAP II score (indicator of more severe illness) were less likely to be discharged when NICUs were crowded.

Nevertheless, these findings suggest that unit workload and strains on staff influenced clinical decisionmaking. Jochen Profit, M.D., M.P.H., of Children's Hospital Boston and Texas Children's Hospital, and colleagues divided the daily census from each of 10 NICUs in Massachusetts and California into quintiles and tested whether discharges were evenly distributed among them. Only in the middle three census quintiles were infants discharged as expected given their clinical status and severity of illness.

Overall, infants discharged at high unit census did not differ from their peers in terms of parental satisfaction, emergency department visits, home nurse visits, or rehospitalization rates. However, given the low illness severity of these moderately preterm infants, these measures may not have been sensitive enough to signal a care quality problem. NICUs will experience staffing constraints for the foreseeable future. Thus, it is important to optimize work processes so that providers can manage their high workload while still providing quality care, suggest the researchers.

See "Neonatal intensive care unit census influences discharge of moderately preterm infants," by Dr. Profit, Marie C. McCormick, M.D., Sc.D., Gabriel J. Escobar, M.D., and others, in the February 2007 Pediatrics 119(2), pp. 314-319.

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