RESUMO
Health policy and quality improvement initiatives exist symbiotically. Quality projects can be spurred by policy decisions, such as the creation of financial incentives for high-value care. Then, advocacy can streamline high-value care, offering opportunities for quality improvement scholars to create projects consistent with evidenced-based care. Thirdly, as pediatrics and neonatology reconcile with value-based payment structures, successful quality initiatives may serve as demonstration projects, illustrating to policy-makers how best to allocate and incentivize resources that optimize newborn health. And finally, quality improvement (QI) can provide an essential link between broad reaching advocacy principles and boots-on-the-ground local or regional efforts to implement good ideas in ways that work practically in particular environments. In this paper, we provide examples of how national legislation elevated the importance of QI, by penalizing hospitals for low quality care. Using Medicaid coverage of pasteurized human donor milk as an example, we discuss how advocacy improved cost-effectiveness of treatments used as tools for quality projects related to reduction of necrotizing enterocolitis and improved growth. We discuss how the future of QI work will assist in informing the agenda as neonatology transitions to value-based care. Finally, we consider how important local and regional QI work is in bringing good ideas to the bedside and the community.
Assuntos
Política de Saúde , Melhoria de Qualidade , Humanos , Recém-Nascido , Estados Unidos , Neonatologia/normas , Medicaid , Leite Humano , Defesa do Paciente , Pasteurização , Enterocolite Necrosante/terapia , Enterocolite Necrosante/prevenção & controle , Enterocolite Necrosante/economiaRESUMO
In a companion paper, we showed how local hospital leaders could assess systems and identify key safety concerns and targets for system improvement. In the present paper, we consider how these leaders might implement practical, low-cost interventions to improve safety. Our focus is on making immediate safety improvements both to directly improve patient care and as a foundation for advancing care in the longer-term. We describe a 'portfolio' approach to safety improvement in four broad categories: prioritising critical processes, such as checking drug doses; strengthening the overall system of care, for example, by introducing multiprofessional handovers; control of known risks, such as only using continuous positive airway pressure when appropriate conditions are met; and enhancing detection and response to hazardous situations, such as introducing brief team meetings to identify and respond to immediate threats and challenges. Local clinical leaders and managers face numerous challenges in delivering safe care but, if given sufficient support, they are nevertheless in a position to bring about major improvements. Skills in improving safety and quality should be recognised as equivalent to any other form of (sub)specialty training and as an essential element of any senior clinical or management role. National professional organisations need to promote appropriate education and provide coaching, mentorship and support to local leaders.
Assuntos
Recursos em Saúde/economia , Neonatologia/organização & administração , Segurança do Paciente/normas , Qualidade da Assistência à Saúde/organização & administração , Países em Desenvolvimento/economia , Países em Desenvolvimento/estatística & dados numéricos , Pessoal de Saúde/educação , Recursos em Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde/métodos , Humanos , Recém-Nascido , Quênia/epidemiologia , Liderança , Tutoria/métodos , Mães/educação , Mães/psicologia , Neonatologia/normas , Segurança do Paciente/estatística & dados numéricos , Melhoria de QualidadeRESUMO
BACKGROUND: Although the complexity and length of treatment is connected to the newborn's maturity and birth weight, most case-mix grouping schemes classify newborns by birth weight alone. The objective of this study was to determine whether the definition of thresholds based on a changepoint analysis of variability of birth weight and gestational age contributes to a more homogenous classification. METHODS: This retrospective observational study was conducted at a Tertiary Care Center with Level III Neonatal Intensive Care and included neonate cases from 2016 through 2018. The institutional database of routinely collected health data was used. The design of this cohort study was explorative. The cases were categorized according to WHO gestational age classes and SwissDRG birth weight classes. A changepoint analysis was conducted. Cut-off values were determined. RESULTS: When grouping the cases according to the calculated changepoints, the variability within the groups with regard to case related costs could be reduced. A refined grouping was achieved especially with cases of >2500 g birth weight. An adjusted Grouping Grid for practical purposes was developed. CONCLUSIONS: A novel method of classification of newborn cases by changepoint analysis was developed, providing the possibility to assign costs or outcome indicators to grouping mechanisms by gestational age and birth weight combined.
Assuntos
Peso ao Nascer , Grupos Diagnósticos Relacionados , Terapia Intensiva Neonatal , Neonatologia/normas , Peso Corporal , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Estudos Retrospectivos , SuíçaRESUMO
OBJECTIVE: Summarize policies on levels of neonatal care designation among 50 states and District of Columbia (DC). STUDY DESIGN: Systematic review of publicly available, web-based information on levels of neonatal care designation policies for each state/DC. Information on designating authorities, designation oversight, licensure requirement, and ongoing monitoring for designated levels of care abstracted from 2019 published rules, statutes, and regulations. RESULT: Thirty-one (61%) of 50 states/DC had designated authority policies for neonatal levels of care. Fourteen (27%) incorporated oversight of neonatal levels of care into the licensure process. Among jurisdictions with designated authority, 25 (81%) used a state agency and 15 (48%) had direct oversight. Twenty-two (71%) of 31 states with a designating authority required ongoing monitoring, 14 (64%) used both hospital reporting and site visits for monitoring with only ten requiring site visits. CONCLUSIONS: Limited direct oversight influences regulation of regionalized systems, potentially impacting facility service monitoring and consequent management of vulnerable infants.
Assuntos
Regulamentação Governamental , Política de Saúde , Recém-Nascido , Neonatologia/legislação & jurisprudência , Governo Estadual , Humanos , Unidades de Terapia Intensiva Neonatal/normas , Licenciamento Hospitalar , Licenciamento em Medicina/legislação & jurisprudência , Neonatologia/normas , Estados UnidosRESUMO
BACKGROUND: Previous studies proposed that there were racial or ethnic disparities in fetal growth, challenging the use of international standards in specific populations. This study was to evaluate the validity of applying the INTERGROWTH-21st standard to a Chinese population for identifying abnormal head circumference (HC), in comparison with a newly generated local reference. METHODS: There were 24,257 singletons delivered by low-risk mothers in four perinatal health-care centers in Southern China. New HC reference was constructed and comparison in distribution of HC categories was performed between the INTERGROWTH-21st standard and new reference after applying these two tools in study population. Logistic regression was used to examine the association between abnormal HC and adverse neonatal outcomes. RESULTS: There were 4.40% of the newborns identified with microcephaly (HC > 2 standard deviation below the mean) using the INTERGROWTH-21st standard, comparing to the proportion of 2.83% using new reference. The newborns identified with microcephaly only by the INTERGROWTH-21st standard were not at a higher risk of adverse neonatal outcome, compared with those identified as non-microcephaly by both tools (OR 0.73, 95% CI 0.47-1.13). CONCLUSION: The new HC reference may be more appropriate for newborn assessment in Chinese populations than the INTERGROWTH-21st standard.
Assuntos
Antropometria , Cabeça/anatomia & histologia , Triagem Neonatal/normas , Neonatologia/normas , Padrões de Referência , Peso ao Nascer , China/epidemiologia , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Microcefalia/diagnóstico , Valores de Referência , Análise de RegressãoRESUMO
BACKGROUND: Tracheal intubation (TI) is one of the most important interventions for the stabilization of critically ill neonates. Competency in airway management is essential for neonatal fellows. No studies have assessed which educational models, techniques, or instructions are perceived by neonatal fellows as the most beneficial for achieving competency in TI. OBJECTIVES: This study identifies which factors are considered most helpful in achieving intubation competency. METHOD: This was a mixed-method study. Semi-structured phone interviews addressed training experience for neonatal intubation. Through qualitative analysis, common themes were identified. RedCap electronic surveys and procedure logs were used to assess procedural experience. RESULTS: Forty-two fellows from 5 programs completed phone interviews. Fellows recalled 6-10 intubation attempts before fellowship. Independent statements related to achieving intubation competency were analyzed and coded into 5 main themes (Procedure, Practice, Perceptual Environment, Personnel, and Preparation). A large proportion of the statements focused on the use of video laryngoscopy. CONCLUSIONS: The themes identified by neonatal-perinatal medicine (NPM) fellows as being the most beneficial in achieving proficiency in neonatal TI are categorized as "The 5 Ps." Careful review of these themes may be utilized to develop validated curriculums that enhance the teaching of TI and optimize the achievement of TI competency among NPM fellows.
Assuntos
Competência Clínica/normas , Bolsas de Estudo , Intubação Intratraqueal/métodos , Neonatologia/educação , Perinatologia/educação , Acreditação , Educação de Pós-Graduação em Medicina , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Laringoscopia , Neonatologia/normas , Perinatologia/normas , Estudos Prospectivos , Inquéritos e Questionários , Estados UnidosRESUMO
OBJECTIVE: We studied decision making regarding inhaled nitric oxide (iNO) in preterm infants with Pulmonary Hypertension (PH). STUDY DESIGN: We asked members of the AAP-Society of Neonatal-Perinatal Medicine and Division-Chiefs to select from three management options- initiate iNO, engage parents in shared decision making or not consider iNO in an extremely preterm with PH followed by rating of factors influencing their decision. RESULTS: Three hundred and four respondents (9%) completed the survey; 36.5% chose to initiate iNO, 42% to engage parents, and 21.5% did not consider iNO. Provider's prior experience, safety, and patient-centered care were rated higher by those who initiated or offered iNO; lack of effectiveness and cost considerations by participants who did not chose iNO. CONCLUSIONS: Most neonatologists offer or initiate iNO therapy based on their individual experience. The minority who chose not to consider iNO placed higher value on lack of effectiveness and cost. These results demonstrate a tension between evidence and pathophysiology-based-therapy/personal experience.
Assuntos
Tomada de Decisão Clínica/métodos , Hipertensão Pulmonar , Doenças do Prematuro/terapia , Terapia Intensiva Neonatal , Óxido Nítrico/uso terapêutico , Insuficiência Respiratória , Administração por Inalação , Atitude do Pessoal de Saúde , Análise Custo-Benefício , Medicina Baseada em Evidências , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/terapia , Lactente Extremamente Prematuro , Recém-Nascido , Terapia Intensiva Neonatal/métodos , Terapia Intensiva Neonatal/normas , Masculino , Neonatologia/métodos , Neonatologia/normas , Guias de Prática Clínica como Assunto , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Estados UnidosRESUMO
BACKGROUND: Family-centered care has been receiving increased attention during the last decades and health professionals recognize family satisfaction with care as an important health indicator. The Empowerment of Parents in The Intensive Care-Neonatology (EMPATHIC-N) is a newly developed, yet empirically reliable and valid measure for the assessment of parental satisfaction with the care provided by Neonatal Intensive Care Units (NICU). The present study aims to present the Greek version of the EMPATHIC-N and to confirm its factorial structure. METHODS: The EMPATHIC-N was translated in Greek using a forward-backward translation and was piloted before use. A sample of 256 families receiving intensive care at the NICU of Archbishop Makarios III Public Hospital in Cyprus which is the only NICU in Cyprus, participated in the validation study of the EMPATHIC-N. Confirmatory factor analyses were performed using SPSS and AMOS 24.0. RESULTS: The Greek version of the EMPATHIC-N had good psychometric characteristics (Cronbach's alpha = .87). The CFAs for the separate subscales of professionalism, organization, information, parental involvement and intervention for the EMPATHIC-N showed that all five subscales represented five distinct components of parental satisfaction with care. The CFA of the general instrument supported that a second-order model with a higher-order factor reflecting the organizational structure (professionalism, intervention and organization loaded on this factor) fitted the data best [χ2 (259) = 405.332, p < .001, ΤLI = .887, CFI = .903, RMSEA = .065 (90% CI .058, .073), SRMR = .0597]. CONCLUSIONS: EMPATHIC-N is a valid and reliable measure for the assessment of parental satisfaction with neonatal care in a Greek-Cypriot context. The organizational dimension of the NICUs is an important component with specific research and clinical implications for the enhancement of parental satisfaction with care.
Assuntos
Terapia Intensiva Neonatal/normas , Satisfação Pessoal , Poder Psicológico , Inquéritos e Questionários/normas , Chipre/etnologia , Análise Fatorial , Saúde da Família/normas , Feminino , Grécia/etnologia , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/organização & administração , Unidades de Terapia Intensiva Neonatal/normas , Masculino , Neonatologia/normas , Pais/psicologia , Psicometria , TraduçõesRESUMO
Treatment modalities for neonates born with congenital diaphragmatic hernia (CDH) have greatly improved in recent times with a concomitant increase in survival. In 2008, CDH EURO consortium, a collaboration of a large volume of CDH centers in Western Europe, was established with a goal to standardize management and facilitate multicenter research. However, limited knowledge on long-term outcomes restricts the identification of optimal care pathways for CDH survivors in adolescence and adulthood. This review aimed to evaluate the current practice of long-term follow-up within the CDH EURO consortium centers, and to review the literature on long-term outcomes published from 2000 onward. Apart from having disease-specific morbidities, children with CDH are at risk for impaired neurodevelopmental problems and failure of educational attainments which may affect participation in society and the quality of life in later years. Thus, there is every reason to offer them long-term multidisciplinary follow-up programs. We discuss a proposed collaborative project using standardized clinical assessment and management plan (SCAMP) methodology to obtain uniform and standardized follow-up of CDH patients at an international level.
Assuntos
Hérnias Diafragmáticas Congênitas/terapia , Neonatologia/normas , Avaliação de Resultados em Cuidados de Saúde , Pediatria/normas , Adolescente , Antropometria , Criança , Pré-Escolar , Ecocardiografia , Europa (Continente) , Seguimentos , Trato Gastrointestinal/patologia , Perda Auditiva Neurossensorial/terapia , Hérnias Diafragmáticas Congênitas/complicações , Hérnias Diafragmáticas Congênitas/diagnóstico , Ventilação de Alta Frequência , Humanos , Hipertensão Pulmonar/terapia , Lactente , Recém-Nascido , Neuroimagem , Qualidade de Vida , Testes de Função Respiratória , Estudos Retrospectivos , Risco , Sociedades Médicas , Inquéritos e Questionários , SobreviventesRESUMO
Work within the US health care system has sought to improve outcomes, decrease costs, and improve the patient experience. Combining those three elements leads to value-added care. Quality improvement within neonatology has focused primarily on the improvement of clinical outcomes without explicit consideration of cost. Future improvement efforts in neonatology should consider opportunities to decrease or eliminate waste, and improve outcomes. Consideration of how a change affects all stakeholders reveals potential cost-saving opportunities, and developing aims with value in mind facilitates understanding and goal-setting with senior administrative leaders.
Assuntos
Terapia Intensiva Neonatal/normas , Neonatologia/normas , Melhoria de Qualidade , Análise Custo-Benefício , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/economia , Unidades de Terapia Intensiva Neonatal/normas , Terapia Intensiva Neonatal/economia , Neonatologia/economia , Estados UnidosRESUMO
OBJECTIVE: The International Liaison Committee on Resuscitation (ILCOR) provides recommendations on neonatal resuscitation training and practice, which includes a template for a decision-making algorithm. We evaluated the design properties of the ILCOR algorithm and four adaptations by member resuscitation organizations using the validated Cognitive Aids in Medicine Assessment Tool (CMAT). STUDY DESIGN: Two experts rated five neonatal resuscitation algorithms against the CMAT and against medical device design criteria. RESULTS: The ILCOR algorithm scored 32 of a possible 60 CMAT points, showing an adherence rate to CMAT of 53%. The ILCOR algorithm scored higher than the design variations by member organizations. Nonetheless, there are design limitations in the ILCOR algorithm. CONCLUSION: In principle, cognitive aids can improve neonatal resuscitation team performance; however, a considered design process that incorporates the full complexity of the 'procedure as performed' is needed to improve future versions of the algorithm for incorporation in international guidelines.
Assuntos
Reanimação Cardiopulmonar/normas , Cognição , Fidelidade a Diretrizes/estatística & dados numéricos , Neonatologia/normas , Algoritmos , Reanimação Cardiopulmonar/educação , Humanos , Recém-Nascido , Neonatologia/educação , Guias de Prática Clínica como AssuntoRESUMO
OBJECTIVE: Ensuring that neonatal-perinatal medicine (NPM) fellows attain competency in performing neonatal procedures is a requirement of training-competent neonatologists. STUDY DESIGN: A survey of NPM fellows was performed to determine the procedural experience of current fellows, investigate techniques used to track procedural experience and examine the methods programs use to verify procedural competency. RESULTS: One hundred and sixty-three fellows in 57 accredited training programs responded to the survey. Reported number of procedures provide contemporary normative data on procedural experience during training. The majority of fellows reported using an online reporting system to track experience. The most common technique to verify procedural competency was supervised practice until an arbitrary number of procedures had been performed. CONCLUSIONS: NPM fellow procedural experience increases significantly for most, but not all, procedures duration training. We speculate that supplemental simulation training for rare neonatal procedures would help ensure the competency of graduating NPM fellows. Experience alone is insufficient to verify competency. Further work on the accurate tracking of experience and verification of procedural competency is needed.
Assuntos
Competência Clínica/normas , Bolsas de Estudo/estatística & dados numéricos , Neonatologia/educação , Perinatologia/educação , Acreditação , Estudos Transversais , Educação de Pós-Graduação em Medicina , Humanos , Neonatologia/normas , Perinatologia/normas , Inquéritos e Questionários , Estados UnidosRESUMO
Rising health care costs challenge governments, payers, and providers in delivering health care services. Tremendous pressures result to deliver better quality care while simultaneously reducing costs. This has led to a wholesale re-examination of current practice methods, including explicit consideration of efficiency and waste. Traditionally, reductions in the costs of care have been considered as independent, and sometimes even antithetical, to the practice of high-quality, intensive medicine. However, it is evident that provision of evidence-based, locally relevant care can result in improved outcomes, lower resource utilization, and opportunities to reallocate resources. This is particularly relevant to the practice of neonatology. In the United States, 12% of the annual birth cohort is affected by preterm birth, and 3% is affected by congenital anomalies. Both of these conditions are associated with costly health care during, and often long after, the NICU admission. We will discuss how 3 drivers of clinical practice in neonatal care (evidence-based medicine, evidence-based economics, and quality improvement) can together optimize clinical and fiscal outcomes.
Assuntos
Unidades de Terapia Intensiva Neonatal/economia , Unidades de Terapia Intensiva Neonatal/normas , Neonatologia/economia , Neonatologia/normas , Medicina Baseada em Evidências , Custos de Cuidados de Saúde , Humanos , Melhoria de Qualidade , Estados UnidosRESUMO
We use the introduction of diagnosis related groups (DRGs) in German neonatology to study the determinants of upcoding. Since 2003, reimbursement is based inter alia on birth weight, with substantial discontinuities at eight thresholds. These discontinuities create incentives to upcode preterm infants into classes of lower birth weight. Using data from the German birth statistics 1996-2010 and German hospital data from 2006 to 2011, we show that (1) since the introduction of DRGs, hospitals have upcoded at least 12,000 preterm infants and gained additional reimbursement in excess of 100 million Euro; (2) upcoding rates are systematically higher at thresholds with larger reimbursement hikes and in hospitals that subsequently treat preterm infants, i.e. where the gains accrue; (3) upcoding is systematically linked with newborn health conditional on birth weight. Doctors and midwives respond to financial incentives by not upcoding newborns with low survival probabilities, and by upcoding infants with higher expected treatment costs.
Assuntos
Peso ao Nascer , Grupos Diagnósticos Relacionados/economia , Neonatologia/economia , Mecanismo de Reembolso/economia , Codificação Clínica/classificação , Codificação Clínica/economia , Codificação Clínica/tendências , Controle de Custos/métodos , Controle de Custos/normas , Controle de Custos/tendências , Interpretação Estatística de Dados , Grupos Diagnósticos Relacionados/classificação , Grupos Diagnósticos Relacionados/estatística & dados numéricos , Alemanha , Indicadores Básicos de Saúde , Mortalidade Hospitalar/tendências , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Formulário de Reclamação de Seguro/economia , Formulário de Reclamação de Seguro/tendências , Tempo de Internação/economia , Tempo de Internação/tendências , Neonatologia/normas , Neonatologia/tendências , Mecanismo de Reembolso/normas , Mecanismo de Reembolso/tendências , Distribuições EstatísticasRESUMO
OBJECTIVES: Targeted neonatal echocardiography refers to a focused assessment of myocardial performance and hemodynamics directed by a specific clinical question. It has become the standard of care in many parts of the world, but practice is variable, and there has been a lack of standardized training and evaluation to date. Targeted neonatal echocardiography was first introduced to Canada in 2006. The purpose of this study was to examine the characteristics of targeted neonatal echocardiography practice and training methods in Canadian neonatal intensive care units (NICUs). METHODS: A total of 142 Canadian neonatologists were invited to participate in an online survey, which was conducted in September 2010. The survey consisted of questions related to the availability of targeted neonatal echocardiography, clinical indications, benefits and risks, and training methods. RESULTS: The overall survey response rate was 65%. Forty-eight respondents (34%) indicated that targeted neonatal echocardiography was available in their units, and the program was introduced within the preceding 1 to 5 years. In centers where it was unavailable, lack of on-site echocardiography expertise was cited as the major barrier to implementation. The most common indications for targeted neonatal echocardiography included evaluation of a hemodynamically significant ductus arteriosus, systemic or pulmonary blood flow, and response to cardiovascular treatments. Only 27% of respondents, working in centers where targeted neonatal echocardiography existed, actually performed the studies themselves; most individuals completed 11 to 20 studies per month. Almost half of the respondents said that training was available in their institutions, but methods of training and evaluation were inconsistent. Eighty-seven percent of respondents reported no formalized process for assessment of ongoing competency after the initial training period. CONCLUSIONS: Targeted neonatal echocardiography is becoming more widely available and is gaining acceptance in Canadian NICUs. Although training is provided in many institutions, the process is not well established, and formal evaluation is rarely performed. This study emphasizes the need for development of standards for formalized training, evaluation, and quality assurance.
Assuntos
Ecocardiografia/estatística & dados numéricos , Ecocardiografia/normas , Cardiopatias Congênitas/diagnóstico por imagem , Neonatologia/educação , Neonatologia/normas , Padrões de Prática Médica/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde , Canadá , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Effective communication, co-operation and teamwork have been identified as key determinants of patient safety. SBAR (Situation, Background, Assessment and Recommendation) is a communication tool recommended by the World Health Organization and the UK National Health Service. SBAR is a structured method for communicating critical information that requires immediate attention and action, contributing to effective escalation of management and increased patient safety. To our knowledge, this is the first study showing use of SBAR in South Africa (SA). OBJECTIVE: To determine the effectiveness of adopting the SBAR communication tool in an acute clinical setting in SA. METHODS: In the first phase of this study, neonatal nurses and doctors at Groote Schuur Hospital, Cape Town, were gathered in a focus group and given a questionnaire asking about communication in the neonatal department. Neonatal nurses and doctors were then trained to use SBAR. RESULTS: A telephone audit demonstrated an increase in SBAR use by registrars from 29% to 70% when calling consultants for help. After training, the majority of staff agreed that SBAR had helped with communication, confidence, and quality of patient care. There was qualitative evidence that SBAR led to greater promptness in care of acutely ill patients. CONCLUSIONS: Adopting SBAR was associated with perceived improvement in communication between professionals and in the quality and safety of patient care. It is suggested that this simple tool be introduced to many other hospitals in SA.
Assuntos
Comunicação , Comunicação Interdisciplinar , Neonatologia/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Segurança do Paciente , Grupos Focais , Humanos , Recém-Nascido , Corpo Clínico Hospitalar/organização & administração , Corpo Clínico Hospitalar/normas , Neonatologia/normas , Assistência ao Paciente/métodos , Assistência ao Paciente/normas , Equipe de Assistência ao Paciente/normas , Qualidade da Assistência à Saúde , África do Sul , Inquéritos e QuestionáriosAssuntos
Humanos , Criança , Neonatologia/normas , Atenção à Saúde , Assistência Integral à Saúde , Controle de Infecções/organização & administração , Monitoramento Epidemiológico , Indicadores e Reagentes , Recém-Nascido , Serviços de Saúde da Criança , Serviços de Saúde , Qualidade da Assistência à Saúde , Segurança do PacienteRESUMO
Neonatal units have the highest incidence of medication errors (approximately 5%) compared to adult and pediatric wards. Medication errors include prescribing errors, transcription errors, dispensing errors, medication administration errors, and monitoring. Dosing error is the most common prescribing error. Prevention of medication error must be global. The implementation of a computerized physician order entry significantly reduces prescribing errors but other preventive measures remain necessary.
Assuntos
Prescrições de Medicamentos/normas , Erros de Medicação/prevenção & controle , Humanos , Recém-Nascido , Neonatologia/normasRESUMO
OBJECTIVE: 1. The transfer rate of mature newborns will be presented as a new quality indicator. 2. Another objective of this study was to adjust the transfer rate of mature newborns of different hospitals according to their "risk" profile of patients by multivariate analysis. METHOD: The perinatal database of 118,416 newborns of the Saxonian quality surveillance from 2001 to 2004 was analysed. Based on 17 clinical and 3 structural factors, a logistic regression model was used to develop a specific "risk" predictor for the quality indicator "transfer rate". RESULTS: For care level III (basic care) a "risk" predictor for the transfer rate was developed, which consists of 15 factors. The AUC(ROC)-value of this quality indicator was 78.6%, which is sufficient. The hospital ranking based on the adjusted risk assessment was different from the hospital ranking prior to this adjustment. The average correction of ranking position was 10.4 for 43 clinics. CONCLUSION: 1. The new quality indicator "transfer rate of mature newborns" can be recommended. 2. The application of the risk adjustment method proposed here allows for a more objective comparison of the quality indicator "transfer rate" among different hospitals.
Assuntos
Departamentos Hospitalares/estatística & dados numéricos , Departamentos Hospitalares/normas , Neonatologia/estatística & dados numéricos , Neonatologia/normas , Transferência de Pacientes/estatística & dados numéricos , Transferência de Pacientes/normas , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/normas , Risco Ajustado/estatística & dados numéricos , Feminino , Alemanha , Hospitais Pediátricos/normas , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Incidência , Recém-Nascido , Modelos Logísticos , Masculino , Análise MultivariadaRESUMO
This contribution describes the regulation of end-of-life decisions in neonatology in the Netherlands. An account is given of the process of formulating rules, which includes a report by the Dutch Association for Paediatrics, two Court rulings, a report by a Consultation Group appointed by the Ministry of Health and a professional Protocol regulating deliberate ending of life in neonatology that was subsequently adopted as the regulation of this type of decision-making at the national level. The paper presents Dutch and comparative data on the attitude of the medical profession towards end-of-life decisions in neonatology and the frequency of such decisions in medical practice.