Characteristics of best‐performing neonatal intensive care units

Abstract

Not all neonatal intensive care units (NICUs) are equal. While differing outcomes can be simply due to differing case-mix, other factors may contribute. US researchers developed a composite morbidity and mortality score (the Benefit Metric) as a measure of performance. Each NICU completed a detailed cultural survey to determine the characteristics of better-performing NICUs. The score was applied retrospectively to 39 NICUs caring for 58 272 very low birthweight infants from 2000 to 2014. The units were ranked into Group A, whose lower 95% confidence interval (CI) was above zero (significantly better than the mean); Group C, whose upper 95% CI was above zero (significantly lower than the mean); and Group B, whose 95% CIs contained zero and were therefore not significantly different from the group mean (Fig. 1). There was a 40% overall improvement in scores from 2000 to 2014 across all groups. The cultural analysis showed that the 14 high-proficiency NICUs in Group A had better morale and greater problem-solving expectations than NICUs in Groups B and C. Group A units were also better at fostering human factors (team work, camaraderie and learning opportunities), had better nurse and doctor staffing levels, better staff retention and had neonatal nurse practitioners who did rounds on very low birth weights (VLBW) babies.