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Characterization of Neonatal Personnel Time Inputs and Prediction From Clinical Variables — A Time and Motion Study

Journal of Perinatology volume 22, pages 658–663 (2002)Cite this article

Abstract

OBJECTIVE: To characterize and predict personnel time inputs to neonatal intensive care using infant characteristics from chart review.

STUDY DESIGN: For 12 hours each day, observers timed all direct care, charting, discussions, and procedures for 154 infants. Time inputs were correlated with 40 infant characteristics and resource markers, as well as the Score for Neonatal Acute Physiology (SNAP) for that day of care.

RESULTS: Nurses accounted for 76%, respiratory therapists 8%, fellows 5%, nurse practitioners 7% and attendings 5% of total time invested in patient care. Nurses and respiratory therapists spent proportionately more time in direct patient care. In regression models, a limited number of variables explained 36% of the variance in time input per patient for respiratory therapists (p<0.0001), 42% for nurses (p<0.0001), and 23% for physicians and nurse practitioners (p<0.0001).

CONCLUSIONS: Total labor inputs can be accurately predicted through the use of a limited number of clinical characteristics. This technique should be routinely employed to improve the accuracy of economic evaluations. Nursing accounts for the majority of time invested in neonatal care. Improved efficiency in neonatology is thus most likely to be generated by interventions that reduce direct nursing time.

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Acknowledgements

The authors gratefully acknowledge the assistance of Shawn Stewart, who assisted with data analysis, and of Ashish Shah, James Godin, and Christine Bumatay, who performed the personnel observations and chart abstraction while participating in the summer student program of the Division of Newborn Medicine, Harvard Medical School. We are also indebted to the nurses, respiratory therapists, staff, and administration of the neonatal intensive care unit of the Beth Israel Deaconess Medical Center for their enthusiastic facilitation of the data collection.

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Authors and Affiliations

  1. Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA

    John A F Zupancic MD, ScD, FRCPC & Douglas K Richardson MD, MBA

  2. Harvard Newborn Medicine Program, Harvard Medical School, Boston, MA, USA

    John A F Zupancic MD, ScD, FRCPC & Douglas K Richardson MD, MBA

  3. Department of Maternal and Child Health, Harvard School of Public Health, Boston, MA, USA

    Douglas K Richardson MD, MBA

Authors
  1. John A F Zupancic MD, ScD, FRCPC
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  2. Douglas K Richardson MD, MBA
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Financial Support

J. A. F. Z. was supported in part by a Clinician-Scientist Award from the Medical Research Council of Canada.

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Zupancic, J., Richardson, D. Characterization of Neonatal Personnel Time Inputs and Prediction From Clinical Variables — A Time and Motion Study. J Perinatol 22, 658–663 (2002). https://doi.org/10.1038/sj.jp.7210821

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