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Introduction of 24 h resident consultant cover in a tertiary neonatal unit—impact on mortality and clinical outcomes

Research output: Contribution to journalArticlepeer-review

Carolina Zorro, Theodore Dassios, Ann Hickey, Anusha Arasu, Ravindra Bhat, Anne Greenough

Original languageEnglish
Article number865
JournalChildren
Volume8
Issue number10
Early online date28 Sep 2021
DOIs
E-pub ahead of print28 Sep 2021
PublishedOct 2021

Bibliographical note

Funding Information: Funding: The research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Funding Information: The research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy?s and St Thomas? NHS Foundation Trust and King?s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

King's Authors

Abstract

Background: We aimed to determine whether the introduction of 24 h cover by resident consultants in a tertiary neonatal unit affected mortality and other clinical outcomes. Methods: Retrospective cohort study in a tertiary medical and surgical neonatal unit between 2010–2020 of all liveborn infants admitted to the neonatal unit. Out of hours cover was rearranged in 2014 to ensure 24 h presence of a senior trained neonatologist (resident consultant). Results: In the study period, 4778 infants were included: 2613 in the pre-resident period and 2165 in the resident period. The median (IQR) time to first consultation by a senior member of staff was significantly longer in the pre-resident period [1.5 (0.6–4.3) h] compared to the resident period [0.5 (0.3–1.5) h, p < 0.001]. Overall, mortality was similar in the pre-resident and the resident periods (3.2% versus 2.3%, p = 0.077), but the mortality of infants born at night was significantly higher in the pre-resident (4.5%) compared to the resident period (2.5%, p = 0.016). The resident period was independently associated with an increased survival to discharge (adjusted p < 0.001, odds ratio: 2.0) after adjusting for gestational age, admission temperature and duration of ventilation. Conclusions: Following introduction of a resident consultant model the mortality and time to consultation after admission decreased.

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