Dependency level of babies on the neonatal unit: a comparison of two different classification systems.
BACKGROUND
Monitoring activity on the neonatal unit is important for planning service provision and as part of monitoring quality of care. The dependency level of the patients cared for must be taken into account as well as the number of patients. Two different systems for determining dependency level are in common use.


OBJECTIVE
To develop a system that would allow the accurate determination of dependency level for babies in our care using both the British Association for Perinatal Medicine and Neonatal Nurses Association definitions and the Northern Neonatal Network definitions and to perform a comparison between these two systems.


METHODS
Forty details relating to current clinical status and treatment being given were recorded daily for every patient on two neonatal units over a 17 month period. These details were recorded in a computer database, and dependency levels were calculated for each patient day using both systems.


RESULTS
A total of 21 905 patient days were recorded for 1555 patients. There was good agreement between the two systems on what constituted the highest level of dependency, but overall comparability was poor, with the two systems assigning comparable dependency levels to only 76% of patient days.


CONCLUSIONS
There is limited comparability in dependency levels between these two widely used systems. There is a need for a standardisation of definitions to allow meaningful comparisons to be made between units.
Yoxall
C W
CW
Neonatal Intensive Care Unit, Liverpool Women's Hospital, Liverpool, UK. Bill.yoxall@lwh-tr.nwest.nhs.uk
Cooke
R W
RW
Shaw
N J
NJ
Subhedar
N V
NV
Weindling
A M
AM
D000465:Algorithms; D016208:Databases, Factual; D004739:England; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration / Q000706:statistics & numerical data*; D020380:Needs Assessment / Q000145:classification*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D006113:United Kingdom; D014600:Utilization Review / Q000379:methods