title: Does after-hours in-house senior physician cover improve standard of care and outcomes in high-risk preterm neonates? A retrospective cohort study.
abstract: OBJECTIVE
  To compare the standard of care and outcomes to discharge for inborn high-risk preterm (gestation <32 weeks) neonates admitted to the neonatal intensive care unit (NICU) before and after adopting an after-hours in-house senior physician cover roster (ISPCR). The ISPCR involved the presence of a consultant neonatologist or neonatal fellow in the NICU until 11 pm.
  
  
  METHODS
  This was a retrospective analysis of prospectively collected data for 12 months before (1 February 2002 to 31 January 2003, epoch 1) and after (1 April 2003 to 31 March 2004, epoch 2) adopting the ISPCR. Short-term neonatal outcomes, including mortality and morbidity such as intraventricular haemorrhage, retinopathy of prematurity, necrotising enterocolitis and chronic lung disease, were examined. The standard of acute care, including admission temperature, correct positioning of tubes and lines, and preventable ventilatory complications in the first 8 h following admission, was also compared.
  
  
  RESULTS
  The numbers (235 in epoch 1, 245 in epoch 2), demographic characteristics and severity of illness (CRIB score) of neonates admitted to the NICU was comparable between epochs. Overall neonatal outcomes did not show significant improvement after adopting an ISPCR, nor were they improved for after-hours admissions in the presence of senior in-house physicians. The standard of acute care was also not significantly different. Minor improvements, such as earlier administration of surfactant, were noted in epoch 2.
  
  
  CONCLUSIONS
  Adoption of an ISPCR was not associated with any significant change in the standard of acute care and short-term outcomes for inborn neonates <32 weeks' gestation.
authors.affiliation: Neonatology Clinical Care Unit, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia. steven.resnick@health.wa.gov.au
authors.forename: Steven
authors.initials: S
authors.lastname: Resnick
authors.forename: Angela
authors.initials: A
authors.lastname: Jacques
authors.forename: Sanjay
authors.initials: S
authors.lastname: Patole
authors.forename: Karen
authors.initials: K
authors.lastname: Simmer
mesh_terms: D039602:After-Hours Care; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal / Q000379:methods / Q000592:standards*; D008297:Male; D008485:Medical Audit; D008505:Medical Staff, Hospital; D017063:Outcome Assessment, Health Care; D010561:Personnel Staffing and Scheduling; D010819:Physician's Role; D047928:Premature Birth; D011787:Quality of Health Care; D012189:Retrospective Studies; D014904:Western Australia