Housestaff experience, workload, and test ordering in a neonatal intensive care unit.
BACKGROUND
Little is known of how the inexperience or the clinical workload of housestaff affects the decisions they make in the neonatal intensive care unit (NICU). The authors hypothesized that less experienced interns would order more tests per infant than more experienced residents, especially under conditions of heavy workload.


METHODS
The NICU at the University of Kentucky A. B. Chandler Medical Center has either an intern or a resident on call by himself or herself at night, a natural setting to compare test ordering by interns and residents. The authors counted the numbers of X rays, analyses of arterial blood gases (ABGs), and electrolyte determinations ordered by the house officers on call for 321 infants from July through November 1993. Data for nine interns and seven residents were compared using multivariate linear regression.


RESULTS
When workload became heavier (about five NICU patients), the interns increased their ordering of ABGs per infant to a significantly greater degree than did the residents (p = .01), with the difference being even greater on weekends when the housestaff were under less supervision (p = .004).


CONCLUSIONS
As workload becomes greater in the NICU, interns order more ABGs per infant than do more experienced residents, especially when the interns are less supervised.
Griffith
C H
CH
Division of General Internal Medicine, University of Kentucky College of Medicine, Lexington 40536-0284, USA.
Desai
N S
NS
Wilson
J F
JF
Griffith
E A
EA
Powell
K J
KJ
Rich
E C
EC
D000046:Academic Medical Centers; D001784:Blood Gas Analysis / Q000191:economics / Q000706:statistics & numerical data*; D004573:Electrolytes / Q000097:blood; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration; D007396:Internship and Residency; D008297:Male; D011446:Prospective Studies; D011859:Radiography / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D013997:Time Factors; D016526:Workload
D004573:Electrolytes