You are here

Article Text

Article menu
Original research
Variation in hospital morbidities in an Australian neonatal intensive care unit network
  1. Mohamed E Abdel-Latif1,2,3,
  2. Oyelola Adegboye4,5,
  3. Gen Nowak6,
  4. Faiz Elfaki7,
  5. Barbara Bajuk8,
  6. Kathryn Glass9,
  7. David Harley9,10
  1. 1 Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Garran, Canberra, ACT, Australia
  2. 2 Department of Public Health, College of Science Health and Engineering, La Trobe University, Bundoora, Melbourne, VIC, Australia
  3. 3 Discipline of Neonatology, School of Medicine and Psychology, College of Health and Medicine, Australian National University, Acton, Canberra, ACT, Australia
  4. 4 Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
  5. 5 Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
  6. 6 Research School of Finance, Actuarial Studies, and Statistics, College of Business and Economics, Australian National University, Acton, Canberra, ACT, Australia
  7. 7 Department of Mathematics, Physics, and Statistics, Qatar University, Doha, Qatar
  8. 8 Critical Care Program, Sydney Children's Hospitals Network, Westmead, Sydney, NSW, Australia
  9. 9 National Centre for Epidemiology and Population Health, Australian National University, Acton, Canberra, ACT, Australia
  10. 10 University of Queensland Centre for Clinical Research (UQCCR), University of Queensland, Brisbane, QLD, Australia
  1. Correspondence to Professor Mohamed E Abdel-Latif, Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Garran, Canberra, ACT, Australia; abdel-Latif.Mohamed{at}act.gov.au

Abstract

Objective There is an expectation among the public and within the profession that the performance and outcome of neonatal intensive care units (NICUs) should be comparable between centres with a similar setting. This study aims to benchmark and audit performance variation in a regional Australian network of eight NICUs.

Design Cohort study using prospectively collected data.

Setting All eight perinatal centres in New South Wales and the Australian Capital Territory, Australia.

Patients All live-born infants born between 23+0 and 31+6 weeks gestation admitted to one of the tertiary perinatal centres from 2007 to 2020 (n=12 608).

Main outcome measures Early and late confirmed sepsis, intraventricular haemorrhage, medically and surgically treated patent ductus arteriosus, chronic lung disease (CLD), postnatal steroid for CLD, necrotising enterocolitis, retinopathy of prematurity (ROP), surgery for ROP, hospital mortality and home oxygen.

Results NICUs showed variations in maternal and neonatal characteristics and resources. The unadjusted funnel plots for neonatal outcomes showed apparent variation with multiple centres outside the 99.8% control limits of the network values. The hierarchical model-based risk-adjustment accounting for differences in patient characteristics showed that discharged home with oxygen is the only outcome above the 99.8% control limits.

Conclusions Hierarchical model-based risk-adjusted estimates of morbidity rates plotted on funnel plots provide a robust and straightforward visual graphical tool for presenting variations in outcome performance to detect aberrations in healthcare delivery and guide timely intervention. We propose using hierarchical model-based risk adjustment and funnel plots in real or near real-time to detect aberrations and start timely intervention.

  • Neonatology
  • Intensive Care Units, Neonatal
  • Health services research

Data availability statement

Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as supplementary information. The data for this study were extracted from The Neonatal Intensive Care Units (NICUs) Data Registry, an ongoing prospective statewide audit of infants admitted to the 10 NICUs in NSW and the ACT during the neonatal period. The data are available on reasonable request from the data custodian, NICUS Data Management Committee, Neonatal Intensive Care Units’ Data Registry, Agency for Clinical Innovation, NSW, Australia. All data relevant to the study are included in the article or uploaded as supplementary information.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/archdischild-2022-324940

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as supplementary information. The data for this study were extracted from The Neonatal Intensive Care Units (NICUs) Data Registry, an ongoing prospective statewide audit of infants admitted to the 10 NICUs in NSW and the ACT during the neonatal period. The data are available on reasonable request from the data custodian, NICUS Data Management Committee, Neonatal Intensive Care Units’ Data Registry, Agency for Clinical Innovation, NSW, Australia. All data relevant to the study are included in the article or uploaded as supplementary information.

    View Full Text

    Supplementary materials

    • Supplementary Data

      This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    • Supplementary Data

      This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Footnotes

    • Twitter @Latifme1

    • Contributors MEA-L: conceptualised and designed the study, contributed to statistical analyses and interpretation, drafted the initial manuscript, led the writing and reviewed and revised the manuscript. OA and FE: designed the statistical plan, carried out the initial analyses and critically reviewed and revised the manuscript. GN: contributed to the statistical interpretation, critically reviewed the statistical methods, analysis and interpretation and critically reviewed and revised the manuscript. BB: coordinated and supervised data collection, retrieved and cleaned the data, contributed to statistical interpretation and critically reviewed and revised the manuscript. KG: contributed to the statistical interpretation critically and reviewed and revised the manuscript. DH: contributed to the study design and statistical interpretation and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted. MEA-L and OA had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.