Inter-organizational pooling of NICU nurses in the Dutch neonatal network: a simulation-optimization study.

Neonatology care, the care for premature and severely ill babies, is increasingly confronted with capacity challenges. The entire perinatal care chain, including the Neonatal Intensive Care Unit (NICU), operates at high occupation levels. This results in refusals, leading to undesirable transports to other centers or even abroad, which affects quality of care, length of stay, and safety of these babies, and places a heavy burden on patients, their families, and involved caregivers. In this work we assess the improvement potential of network collaboration strategies that focus on reducing the number of patient transports, by allowing flexible deployment of nurses over the existing NICUs to match short-term changes in patient demand. We develop a discrete event simulation with an integrated optimization module for shift allocation and transfer optimization. A case study for the Dutch national NICU network, involving 9 NICU locations and current transport of 15% of all NICU patients in case of no flexible deployment, shows the potential of transporting staff instead of patients: About 70% of patient transports can be eliminated in case of 15-50% capacity sharing, and about 35% of nationwide transports is eliminated with up to 15% capacity sharing in the Dutch's main conurbation area only.