Trends in the NICU: a review of 25 years' experience.

A review of 25,448 admissions was performed to evaluate the progress of neonatal intensive care at Weill Cornell Medical Center since 1978. Patients were identified by a review of admission and discharge data compiled by admitting staff. The following data were collected: birth weight, gestational age, place of birth (inborn versus outborn), discharge date, disposition. Length of stay was computed from these data. Data were organized according to year of admission. Admissions remained relatively constant with time. However the percentage of inborn infants steadily increased. Survival of the smallest infants (<600 g) remained poor, but overall survival of all infants improved over time. Length of stay for infants 1000 to 2000 g fell over time while that of other infants remained constant. These trends reflect changes in obstetric and neonatal practice over time, and include improved methods of antenatal care, neonatal pulmonary care, and nutrition, as well as changes in the distribution of neonatal and high-risk maternal care.

Impact of a computerized alert during physician order entry on medication dosing in patients with renal impairment.

Computerized assistance to clinicians during physician order entry can provide protection against medical errors. However, computer systems that provide too much assistance may adversely affect training of medical students and residents. Trainees may rely on the computer to automatically perform complex calculations and create appropriate orders and are thereby deprived of an important educational exercise. An alternative strategy is to provide a critique at the completion of an order, requiring the trainee to enter the entire order but displaying an alert if an error is made. While this approach preserves the educational components of order-writing, the potential for errors exists if the computerized critique does not induce clinicians to correct the order. The goal of this study was to determine (a) the frequency with which errors are made by trainees in an environment in which renal dosing adjustment calculation for antimicrobials are done by the system after the user has entered an order, and (b) the frequency with which prompts to clinicians regarding these errors leads to correction of those orders.