Towards effective capacity planning in a perinatal network centre

Objective To study the arrival pattern and length of stay (LoS) in a neonatal intensive care/high dependency unit (NICU/HDU) and special care baby unit (SCBU) and the impact of capacity shortage in a perinatal network centre, and to provide an analytical model for improving capacity planning. Methods The data used in this study have been collected through the South England Neonatal Database (SEND) and the North Central London Perinatal Network Transfer Audit between 1 January and 31 December 2006 for neonates admitted and refused from the neonatal unit at University College London Hospital (UCLH). Exploratory data analysis was performed. A queuing model is proposed for capacity planning of a perinatal network centre. Outcome measures Predicted number of cots required with existing arrival and discharge patterns; impact of reducing LoS. Results In 2006, 1002 neonates were admitted to the neonatal unit at UCLH, 144 neonates were refused admission to the NICU and 35 to the SCBU. The model shows the NICU requires seven more cots to accept 90% of neonates into the NICU. The model also shows admission acceptance can be increased by 8% if LoS can be reduced by 2 days. Conclusions The arrival, LoS and discharge of neonates having gestational ages of <27 weeks were the key determinants of capacity. The queuing model can be used to determine the cot capacity required for a given tolerance level of admission rejection

ERNICA guidelines for the management of rectosigmoid Hirschsprung's disease

Background Hirschsprung's disease (HSCR) is a serious congenital bowel disorder with a prevalence of 1/5000. Currently, there is a lack of systematically developed guidelines to assist clinical decision-making regarding diagnostics and management. Aims This guideline aims to cover the diagnostics and management of rectosigmoid HSCR up to adulthood. It aims to describe the preferred approach of ERNICA, the European Reference Network for rare inherited and congenital digestive disorders. Methods Recommendations within key topics covering the care pathway for rectosigmoid HSCR were developed by an international workgroup of experts from 8 European countries within ERNICA European Reference Network from the disciplines of surgery, medicine, histopathology, microbiology, genetics, and patient organization representatives. Recommendation statements were based on a comprehensive review of the available literature and expert consensus. AGREE II and GRADE approaches were used during development. Evidence levels and levels of agreement are noted. Results Thirty-three statements within 9 key areas were generated. Most recommendations were based on expert opinion. Conclusion In rare or low-prevalence diseases such as HSCR, there remains limited availability of high-quality clinical evidence. Consensus-based guidelines for care are presented.Peer reviewe

The Role of Occupational Therapists in the Neonatal Intensive Care Units

The purpose of this research is to explore the role of occupational therapy (OT) within neonatal intensive care units (NICUs). There has been limited research pertaining to the current overall role of OTs in the NICU. In order to explain/demonstrate the multifaceted role of OTs within the NICU, a survey was created and, using a stratified random sample, distributed to 90 NICUs in hospitals throughout the United States (U.S.). A non-experimental exploratory survey research design was used to gather and analyze information from respondents. A survey was created by the researchers based on a thorough literature review of the topic and development of 4 hypotheses statements. The survey consisted of 16 quantitative and qualitative items, which were divided under three main headings: NICU work setting and staffing level, OT professional background, and description of the NICU OT practice role, including theoretical models used. After pilot testing and UND Institutional Review Board approval, the survey was mailed out to 15 occupational therapy departments of hospitals in six regions of the United States (U.S.), totaling a sampling frame distribution of 90 hospitals. Of the 90 occupational therapy departments receiving the survey, there were 19 respondents for a response rate of 21%. No follow-up requests for survey completion were sent out. Thirteen surveys fully completed by occupational therapists were included in the final analyses. Quantitative survey item responses were descriptively analyzed using Microsoft Excel 2007™ and SPSS 18®; qualitative responses were compiled into thematic areas using Microsoft Word 2007™. OTs are employed in 68% of the U.S. NICU settings sampled in this survey research study. There is a multifaceted role served by OTs in the NICU, such as providing parental education, stress signal education, positioning, feeding/pre-feeding, as well as many other interventions. Al’s Synactive Theory (Als, 1982) was used by the majority (46.15%) of the OT respondents as a guiding theoretical practice model. Because of the specialized knowledge base and skill necessary, the OTs employed in the NICU have an average of 4.9 years of pediatric experience prior to employment in the NICU. Due to the low response rate (21%), comparison of the interventions utilized by OTs in the NICU across the U.S. could not be completed. Conclusion: This survey and its results are recommended to form the basis for further study of the employment of occupational therapists in NICUs across the U.S., including the value of OT brought to the NICU team and client outcomes. These study results are intended to be presented in a poster format and/or publication for occupational therapy audiences in order to promote awareness and further research of this important specialty area of occupational therapy practic