G120(P) Current Neonatal Resident Consultant Workforce in Level 3 NICUs in UK

Abstract

Background Peri- and postnatal events involving newborns occur 24/7 and to improve the quality of care given to this group of babies on NICUs, there has been calls from, Academy of Royal Medical Colleges, RCPCH, BAPM, government (DoH Neonatal Toolkit) to add on or augment the tier 3 level medical staffing out-of-hours leading to a consultant-delivered type of service. This has also become necessary to help plug the shortage in tier 2 medical staffing as a result of the MMC agenda and EWTD. The provision of this level of service, offers a lot of benefits including rapid appropriate diagnosis, intervention, clinical management decision making, more efficient use of resources, improves parent’s experience and arguably outcomes. From the training viewpoint, the contact time of trainees with consultants is also optimised leading to better supervised training. As a progressive specialty, some NICUs over the last few years, have introduced and incorporated Resident Neonatal Consultant (RNC) roles into their rotas. This is the very first national survey looking at the current use of these group of specialist Aims To determine- number of L3 NICUs that employ RNCs total number employed levels of medical staff cover at night (as a proxy of out-of-hours cover) whether this involves RNCs and at what tier Night medical roles of ANNPs Methods Telephone interview survey L3 NICUs in UK Period Oct –Dec 2013 Results All L3 NICUs were surveyed = 63 Employed in 11/63 (17.5%) of Trust = England 5/42 (12%); Scotland 6/9 (67%); Wales 0/6; NI 0/5 (Figure 1) Total Number employed 48.5 = England 27.5; Scotland 21 Number of night they cover = 2–7 nights/week Number who are used on Tier 2 & 3 rota = 7 & 4 (and dual role in 3) Units with 1, 2, 3 and 4 medical staff at night= 3, 38, 17 and 5 respectively Figure 2) Units using ANNPs on night medical rota = 22/63. Abstract G120(P) Figure 1 No Resident Neonatal Consultants employed in Level 3 NICUs. Abstract G120(P) Figure 2 Night staffing on Level 3 NICUS. Conclusions <1/5 of L3 NICUs in UK are using RNC at both Tier 2 and 3 with a dual purpose of covering middle grade rota (tier 2) and to improve services through consultant-delivered care (tier 3) Scottish NICUs lead the way in the used of RNCs Level of medical staff night cover varies ANNPs play a crucial role in the medical staffing of NICUs

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

“…Similar recommendations have been made to improve the quality of care given to infants in neonatal units by the Royal College of Paediatrics and Child Health [3] and the Department of Health [5]. Although, these recommendations have been in place for a number of years and in the recent years some units in the United Kingdom have introduced resident consultant cover, the effect of this intervention on neonatal outcomes has not been evaluated in the UK [6]. Studies from Australia [7] and Canada [8] have reported no significant differences in neonatal or neurodevelopment outcomes at three years of age, but the studies were relatively small and their results might not be directly applicable to a different health system.…”