Dependency level of babies on the neonatal unit: a comparison of two different classification systems

Background-Monitoring activity on the neonatal unit is important for planni ng service provision and as part of monitoring quality of care. The depende ncy level of the patients cared for must be taken into account as well as t he number of patients. Two different systems for determining dependency lev el are in common use. Aim-To develop a system that would allow the accurate determination of depe ndency level for babies in our care using both the British Association for Perinatal Medicine and Neonatal Nurses Association definitions and the Nort hern Neonatal Network definitions and to perform a comparison between these two systems. Method-Forty details relating to current clinical status and treatment bein g given were recorded daily for every patient on two neonatal units over a 17 month period. These details were recorded in a computer database, and de pendency levels were calculated for each patient day using both systems. Results-A total of 21 905 patient days were recorded for 1555 patients. The re was good agreement between the two systems on what constituted the highe st level of dependency, but overall comparability was poor, with the two sy stems assigning comparable dependency levels to only 76% of patient days. Conclusions-There is limited comparability in dependency levels between the se two widely used systems. There is a need for a standardisation of defini tions to allow meaningful comparisons to be made between units.