Housestaff workload and procedure frequency in the neonatal intensive careunit

Objective: To investigate the association of clinical workload and the deci sion to perform procedures on infants in the neonatal intensive care unit ( NICU), Design: Prospective cohort study over one academic year, observing infants exposed to housestaff working under various levels of clinical workload. Subjects: All 31 housestaff rotating on the NICU service during the academi c year 1993 to 1994 were observed. A total of 785 infants were admitted to these housestaff. Setting: One academic Level III intensive care nursery. Measurements and Main Results: Clinical workload was operationalized as num ber of NICU infants cared for by the individual houseofficer on call each n ight. The procedures of interest were number of umbilical artery catheters (UACs), intubations, lumbar punctures (LPs), and peripheral phlebotomy perf ormed by the houseofficer on-call. Using multiple linear regression approac hes, controlling for the average severity of-illness of each of the NICU in fants, the experience and residency program of the houseofficer on call, an d the individual attending, we found that increased clinical workload (numb er of NICU infants) resulted in a significantly greater probability that an admitted infant received an umbilical artery catheter (p =.02), but result ed in less probability that any NICU infant received a lumbar puncture (p = .0001) or peripheral phlebotomy (p =.0002). The decision to intubate an inf ant was not affected by the workload in the NICU. Conclusions: The clinical workload of housestaff in the NICU can affect dec isions to perform procedures on infants in the NICU. For equivalently sever ely ill infants, there is a greater chance of receiving a UAC and less chan ce of being phlebotomized or receiving an LP when workload is high. Attendi ng neonatologists need to be sensitive to possible effects of workload on p atient care in the NICU.