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Abstract
Background Peri- and postnatal events involving newborns occur 24/7 and to improve the quality of care given to this group of babies on NICUs, there has been calls from, Academy of Royal Medical Colleges, RCPCH, BAPM, government (DoH Neonatal Toolkit) to add on or augment the tier 3 level medical staffing out-of-hours leading to a consultant-delivered type of service. This has also become necessary to help plug the shortage in tier 2 medical staffing as a result of the MMC agenda and EWTD.
The provision of this level of service, offers a lot of benefits including rapid appropriate diagnosis, intervention, clinical management decision making, more efficient use of resources, improves parent’s experience and arguably outcomes. From the training viewpoint, the contact time of trainees with consultants is also optimised leading to better supervised training.
As a progressive specialty, some NICUs over the last few years, have introduced and incorporated Resident Neonatal Consultant (RNC) roles into their rotas.
This is the very first national survey looking at the current use of these group of specialist
Aims To determine-
number of L3 NICUs that employ RNCs
total number employed
levels of medical staff cover at night (as a proxy of out-of-hours cover)
whether this involves RNCs and at what tier
Night medical roles of ANNPs
Methods
Telephone interview survey L3 NICUs in UK
Period Oct –Dec 2013
Results
All L3 NICUs were surveyed = 63
Employed in 11/63 (17.5%) of Trust = England 5/42 (12%); Scotland 6/9 (67%); Wales 0/6; NI 0/5 (Figure 1)
Total Number employed 48.5 = England 27.5; Scotland 21
Number of night they cover = 2–7 nights/week
Number who are used on Tier 2 & 3 rota = 7 & 4 (and dual role in 3)
Units with 1, 2, 3 and 4 medical staff at night= 3, 38, 17 and 5 respectively Figure 2)
Units using ANNPs on night medical rota = 22/63.
No Resident Neonatal Consultants employed in Level 3 NICUs.
Night staffing on Level 3 NICUS.
Conclusions
<1/5 of L3 NICUs in UK are using RNC at both Tier 2 and 3 with a dual purpose of covering middle grade rota (tier 2) and to improve services through consultant-delivered care (tier 3)
Scottish NICUs lead the way in the used of RNCs
Level of medical staff night cover varies
ANNPs play a crucial role in the medical staffing of NICUs