An Assessment of Pediatric Resident Disaster Preparedness for the Neonatal Intensive Care Unit

Abstract Objective: To assess the level of neonatal intensive care unit (NICU) disaster preparedness among pediatric residents. Methods: A mixed-methods study including qualitative interviews and quantitative surveys was used. Interviews guided survey development. Surveys were distributed to residents who rotated through Children’s National NICU. Questions assessed residents’ background in disaster preparedness, disaster protocol knowledge, NICU preparedness, roles during surge and evacuation, and views on training and education. Results: Survey response was 62.5% (n = 80) with 51.3% of invited residents completing it. Pediatric residents (PGY-2 and PGY-3) (n = 41) had low levels of individual disaster preparedness, particularly evacuations (86%). None were aware of specific NICU disaster protocols. Patient acuity, role ambiguity, knowledge, and training deficits were major contributors to unpreparedness. Residents viewed their role as system facilitators (eg, performing duties assigned, recruiting other residents, and clerical work like documentation). Resident training requests included disaster preparedness training every NICU rotation (48%) using multidisciplinary simulations (66%), role definition (56%), and written protocols (50%). Despite their unpreparedness, residents (84%) were willing to respond. Conclusion: Pediatric residents lacked knowledge of NICU disaster response but were willing to respond to disasters. Training should include multi-disciplinary simulations that can be refined iteratively to clarify roles, and residents should be involved in planning and execution.

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A Controlled Trial of Nurse Practitioners in Neonatal Intensive Care

PEDIATRICS ◽

10.1542/peds.98.6.1143 ◽

1996 ◽

Vol 98 (6) ◽

pp. 1143-1148

Author(s):

Alba Mitchell-DiCenso ◽

Gordon Guyatt ◽

Michael Marrin ◽

Ron Goeree ◽

Andrew Willan ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Infant Development ◽

Controlled Trial ◽

Parent Satisfaction ◽

Pediatric Resident ◽

Pediatric Residents ◽

Resident Group

Objective. To compare a clinical nurse specialist/neonatal practitioner (CNS/NP) team with a pediatric resident team in the delivery of neonatal intensive care. Design. Randomized, controlled trial. Setting. A 33-bed tertiary-level neonatal intensive care unit. Patients. Of 821 infants admitted to the neonatal intensive care unit between September 1991 and September 1992, 414 were randomized to care by the CNS/NP team, and 407 were randomized to care by the pediatric resident team. Intervention. Infants assigned to the CNS/NP team were cared for by CNS/NPs during the day and by pediatric residents during the night. Infants assigned to the pediatric resident team were cared for by pediatric residents around the clock. Neonatologists supervised both teams. Measures. Outcome measures included mortality; number of neonatal complications; length of stay; quality of care, as assessed by a quantitative indicator condition approach; parent satisfaction with care, measured using the Neonatal Index of Parent Satisfaction; long-term outcomes, measured using the Minnesota Infant Development Inventory; and costs. Results. There were 19 (4.6%) deaths in the CNS/NP group and 24 (5.9%) in the resident group (relative risk [RR], 0.78; confidence interval [CI], 0.43 to 1.40). In the CNS/NP group, 230 (55.6%) neonates had complications, in comparison with 220 (54.1%) in the resident group (RR, 1.03; CI 0.91 to 1.16). Mean lengths of stay were 12.5 days in the CNS/NP group and 11.7 days in the resident group (difference in means, 0.8 days; CI, -1.1 to 2.7). The performance on the indicator conditions was comparable in the two groups except for two instances, jaundice and charting, both of which favored the CNS/NP group. Mean scores on the Neonatal Index of Parent Satisfaction were 140 in the CNS/NP group and 139 in the resident group (difference in means, 1.0; CI, -3.6 to 5.6). In the CNS/NP group, 6 (2.6%) infants performed 30% or more below their age level in the Minnesota Infant Development Inventory, in comparison with 2 (0.9%) in the resident group (RR, 2.87; CI, 0.59 to 14.06) The cost per infant in the CNS/NP group was $14 245 and in the resident group $13 267 (difference in means, $978; CI, -1303.18 to 3259.05). Conclusions. CNS/NP and resident teams are similar with respect to all tested measures of performance. These results support the use of CNS/NPs as an alternative to pediatric residents in delivering care to critically ill neonates.

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Replacing the Work of Pediatric Residents: Strategies and Issues

PEDIATRICS ◽

10.1542/peds.85.6.1109 ◽

1990 ◽

Vol 85 (6) ◽

pp. 1109-1111

Author(s):

DANIEL D. CHAPMAN ◽

JOAN E. HODGMAN ◽

ROBERT L. JOHNSON ◽

NANCY M. MATLIN

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Training Programs ◽

Pediatric Residents ◽

Residency Programs ◽

Pediatric Residency ◽

Pediatric Inpatient ◽

Inpatient Population

In this issue, Honigfeld et al1 discuss manpower strategies adopted by nine hospitals that either discontinued or significantly reduced their pediatric residency programs. Several of the hospitals surveyed had a significant pediatric inpatient population and two thirds had a Neonatal Intensive Care Unit. The loss of resident positions represented a major manpower crisis for these institutions. The 16 hospitals that originally met the study guidelines in 1986 to 1987 represent only a small fraction of the existing 234 accredited training programs.

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Association of Resident Duty Hour Restrictions, Level of Trainee, and Number of Available Residents with Mortality in the Neonatal Intensive Care Unit

American Journal of Perinatology ◽

10.1055/s-0038-1627442 ◽

2018 ◽

Vol 35 (09) ◽

pp. 911-918 ◽

Cited By ~ 1

Author(s):

Karin Clement ◽

Guy Lacroix ◽

Sylvie Bélanger ◽

Anne-Sophie Julien ◽

Bruno Piedboeuf ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Early Mortality ◽

Hours Worked ◽

Pediatric Residents ◽

Level 3 ◽

Resident Duty

Objective This article assesses the effect of reducing consecutive hours worked by residents from 24 to 16 hours on yearly total hours worked per resident in the neonatal intensive care unit (NICU) and evaluates the association of resident duty hour reform, level of trainee, and the number of residents present at admission with mortality in the NICU. Study Design This is a 6-year retrospective cohort study including all pediatric residents working in a Level 3 NICU (N = 185) and infants admitted to the NICU (N = 8,159). Adjusted odds ratios (aOR) were estimated for mortality with respect to Epoch (2008–2011 [24-hour shifts] versus 2011–2014 [16-hour shifts]), level of trainee, and the number of residents present at admission. Results The reduction in maximum consecutive hours worked was associated with a significant reduction of the median yearly total hours worked per resident in the NICU (381 hour vs. 276 hour, p < 0.01). Early mortality rate was 1.2% (50/4,107) before the resident duty hour reform and 0.8% (33/4,052) after the reform (aOR, 0.57; 95% confidence interval [CI], 0.33–0.98). Neither level of trainee (aOR, 1.22; 95% CI, 0.71–2.10; junior vs. senior) nor the number of residents present at admission (aOR, 2.08; 95% CI, 0.43–10.02, 5–8 residents vs. 0–2 residents) were associated with early mortality. Resident duty hour reform was not associated with hospital mortality (aOR, 0.73; 95% CI, 0.50–1.07; after vs. before resident duty hour reform). Conclusion Resident duty hour restrictions were associated with a reduction in the number of yearly hours worked by residents in the NICU as well as a significant decrease in adjusted odds of early mortality but not of hospital mortality in admitted neonates.

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Evaluation of a Storybook Resource for Parents in the Neonatal Intensive Care Unit

The Journal of Perinatal Education ◽

10.1891/1058-1243.27.4.220 ◽

2018 ◽

Vol 27 (4) ◽

pp. 220-232

Author(s):

Gerri C. Lasiuk ◽

Julie Penner ◽

Karen Benzies ◽

Jodi Jubinville ◽

Kathy Hegadoren ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Preterm Birth ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Qualitative Interviews ◽

Educational Resource ◽

Level Ii ◽

Almost All

This project evaluates the acceptability and utilityof a storybook, entitled Unexpected: Parents’ Experience of Preterm Birth, as an educational resource for parents in the neonatal intensive care unit (NICU). Forty-nine parents were recruited from Level II and Level III NICUs and completed several questionnaires; a subset of 11 parents also participated in focused qualitative interviews. Almost all parents experienced the characters as believable and agreed/strongly agreed that the stories accurately portray what it is like to be a parent in the NICU. The multiple narrators offer different perspectives of the NICU experience, which helped to normalize their experience and reminded them that they were not alone. Participants reported learning something new from the storybook and would recommend it to others.

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Neonatal Intensive Care Unit Boot Camp: A Preparatory Curriculum for Pediatric Residents

MedEdPORTAL ◽

10.15766/mep_2374-8265.10720 ◽

2018 ◽

Vol 14 (1) ◽

Cited By ~ 2

Author(s):

Jeffrey W. Surcouf ◽

Christy G. Mumphrey ◽

Brian M. Barkemeyer ◽

Marlene Buis ◽

Raegan W. Gupta ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Boot Camp ◽

Pediatric Residents

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The Psychosocial Aspects of Feeding in the Neonatal Intensive Care Unit and Beyond

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_persp-19-00097 ◽

2019 ◽

Vol 4 (6) ◽

pp. 1507-1515

Author(s):

Lauren L. Madhoun ◽

Robert Dempster

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Hospital Discharge ◽

Neonatal Intensive Care ◽

Oral Feeding ◽

Medical Attention ◽

Primary Role ◽

Speech Language Pathologists ◽

The Family

Purpose Feeding challenges are common for infants in the neonatal intensive care unit (NICU). While sufficient oral feeding is typically a goal during NICU admission, this can be a long and complicated process for both the infant and the family. Many of the stressors related to feeding persist long after hospital discharge, which results in the parents taking the primary role of navigating the infant's course to ensure continued feeding success. This is in addition to dealing with the psychological impact of having a child requiring increased medical attention and the need to continue to fulfill the demands at home. In this clinical focus article, we examine 3 main areas that impact psychosocial stress among parents with infants in the NICU and following discharge: parenting, feeding, and supports. Implications for speech-language pathologists working with these infants and their families are discussed. A case example is also included to describe the treatment course of an infant and her parents in the NICU and after graduation to demonstrate these points further. Conclusion Speech-language pathologists working with infants in the NICU and following hospital discharge must realize the family context and psychosocial considerations that impact feeding progression. Understanding these factors may improve parental engagement to more effectively tailor treatment approaches to meet the needs of the child and family.

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