Introduction of 24 h Resident Consultant Cover in a Tertiary Neonatal Unit-Impact on Mortality and Clinical Outcomes.

BACKGROUND

We aimed to determine whether the introduction of 24 h cover by resident consultants in a tertiary neonatal unit affected mortality and other clinical outcomes.

METHODS

Retrospective cohort study in a tertiary medical and surgical neonatal unit between 2010-2020 of all liveborn infants admitted to the neonatal unit. Out of hours cover was rearranged in 2014 to ensure 24 h presence of a senior trained neonatologist (resident consultant).

RESULTS

In the study period, 4778 infants were included: 2613 in the pre-resident period and 2165 in the resident period. The median (IQR) time to first consultation by a senior member of staff was significantly longer in the pre-resident period [1.5 (0.6-4.3) h] compared to the resident period [0.5 (0.3-1.5) h, < 0.001]. Overall, mortality was similar in the pre-resident and the resident periods (3.2% versus 2.3%, = 0.077), but the mortality of infants born at night was significantly higher in the pre-resident (4.5%) compared to the resident period (2.5%, = 0.016). The resident period was independently associated with an increased survival to discharge (adjusted < 0.001, odds ratio: 2.0) after adjusting for gestational age, admission temperature and duration of ventilation.

CONCLUSIONS

Following introduction of a resident consultant model the mortality and time to consultation after admission decreased.