We greatly appreciate the thoughtful comments expressed in this letter1 by a member of the Journal’s editorial board. As she correctly notes, neonatology is a team effort, one that requires the contributions of many members of the team all working toward the ultimate health and well-being of critically ill infants. We strongly agree, and at Duke our daily multidisciplinary rounds include our patients’ parents and/or family support when they are available, multiple physicians at various levels of training, neonatal nurse practitioners, bedside nurses who often become an infant’s ‘primary’ nurse, respiratory therapists, pharmacists, dietitians, social workers, patient resource managers, as well as speech/occupational/and physical therapists. After working their night shifts, our upper-level residents join this team for rounds the next morning, both contributing to and learning from discussions around the important social concerns addressed by the editor. Our unit also conducts twice daily ‘huddles’ that incorporate all members of the team, with special focus on the social aspects of care, as well as weekly multidisciplinary psychosocial rounds in which both short-term and long-term patient and family needs are anticipated and addressed.
That said, in the duty-hour-restricted world in which we live we believe the limited time available for residents to perform evening sign-out should primarily be focused on our patients’ clinical needs. We must ensure that our trainees gain an understanding of and pay attention to the underlying pathophysiology that endangers the lives of our critically ill infants on a minute-to-minute basis. This need is what we sought to address with our study, and we hope our evening handoff model provides some guidance for practitioners—especially those working with trainees—to begin building a framework of neonatal clinical knowledge and improve patient safety. Without a continual focus on team-based, high-quality clinical care, infants who do survive to discharge would be more likely to be saddled with chronic, preventable morbidities that, especially under challenging social circumstances, only further compound their chances of death at home.
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