Abstract
Neonatal intensive care is extremely expensive; there is both a financial and an ethical obligation to practice efficiently. In the current era of intense cost containment in hospital care, neonatologists and hospital administrators are under pressure to find strategies for cost reduction for neonatal services. In this review, we address reducing discretionary admissions, the high costs of low-cost testing, minimizing use of selected high-cost technologies (ventilators and parenteral nutrition), shortening length of stay, and optimizing nursing allocation.
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References
Lewit EM, Baker LS, Corman H, Shiono PH The direct cost of low birth weight Future Child 1995 5 (1)35–56
Schroeder SA, Showstack JA, Roberts HE Frequency and clinical description of high-cost patients in 17 acute-care hospitals N Engl J Med 1979 300(23)1306–1309
Zook CJ, Moore FD High-cost users of medical care N Engl J Med 1980 302 (18)996–1002
Imershein AW, Turner C, Wells JG, Pearman A Covering thecosts of care in neonatal intensive care units Pediatrics 1992 89 (1)56–61
Long SH, Marquis MS, Harrison ER The costs and financing of perinatal care in the United States Am J Public Health 1994 84 (9)1473–1478
Pollack MM, Ruttimann UE, Glass NL, Yeh TS Monitoring patients in pediatric intensive care Pediatrics 1985 76 (5)719–724
Pollack MM, Getson PR, Ruttimann UE, et al Efficiency of intensive care. A comparative analysis of eight pediatric intensive care units JAMA 1987 258 (11)1481–1486
Wagner DP, Knaus WA, Draper EA, Zimmerman JE Identification of low-risk monitor patients within a medical–surgical intensive care unit Med Care 1983 21 (4)425–434
Singer DE, Carr PL, Mulley AG, Thibault GE Rationing intensive care — physician responses to a resource shortage N Engl J Med 1983 309 (19)1155–1160
Strauss MJ, LoGerfo JP, Yeltatzie JA, Temkin N, Hudson LD Rationing of intensive care unit services. An everyday occurrence JAMA 1986 255 (9)1143–1146
Zupancic JA, Richardson DK Characterization of the triage process in neonatal intensive care Pediatrics 1998 102 (6)1432–1436
Roblin DW, Richardson DK, Thomas E, et al Variation in the use of alternative levels of hospital care for newborns in a managed care organization Health Serv Res 2000 34(7)1535–1553
Escobar GJ, Li DK, Armstrong MA, et al Neonatal “Sepsis Work-Ups” in babies >2000 grams at birth: a population-based study Pediatrics 2000[In press]
Escobar GJ The neonatal “sepsis work-up”: personal reflections on the development of an evidence-based approach toward newborn infections in a managed care organization Pediatrics 1999 103 (1 Suppl E)360–373
Newman TB, Escobar GJ, Gonzales VM, Armstrong MA, Gardner MN, Folck BF Frequency of neonatal bilirubin testing and hyperbilirubinemia in a large health maintenance organization Pediatrics 1999 104 (5 Pt 2)1198–1203
Escobar GJ, Gonzales VM, Armstrong MA, et al Rehospitalization for neonatal dehydration: a nested case–control study Arch Pediatr Adolesc Med 2000[In press]
British Association of Perinatal Medicine Report of working group of the British Association of Perinatal Medicine and Neonatal Nurses Association on categories of babies requiring neonatal care Arch Dis Child 1992 67 (7 Spec No)868–869
Phibbs CS, Phibbs RH, Wakeley A, Schlueter MA, Sniderman S, Tooley WH Cost effects of surfactant therapy for neonatalrespiratory distress syndrome J Pediatr 1993 123 (6)953–962
Wach R, Darlow B, Bourchier D, Broadbent R, Knight D, Selby R Respiratory distress syndrome in New Zealand: evidence from the OSIRIS trial of exogenous surfactant (Exosurf) N Z Med J 1994 107 (980)234–237
Crowley P, Chalmers I, Keirse MJ The effects of corticosteroid administration before preterm delivery: an overview of the evidence from controlled trials Br J Obstet Gynaecol 1990 97(1)11–25
Wright LL, Verter J, Younes N, et al Antenatal corticosteroid administration and neonatal outcome in very low birth weight infants: the NICHD Neonatal Research Network Am J Obstet Gynecol 1995 173 (1)269–274
Investigators of the Vermont-Oxford Trials Network The Vermont-Oxford Trials Network: very low birth weight outcomes for 1990. Investigators of the Vermont-Oxford Trials Network Database Project Pediatrics 1993 91 (3)540–545
Avery ME, Tooley WH, Keller JB, et al Is chronic lung disease in low birth weight infants preventable? A survey of eight centers Pediatrics 1987 79 (1)26–30
Bednarek FJ, Weisberger S, Richardson DK, Frantz ID, 3rd, Shah B, Rubin LP Variations in blood transfusions among newborn intensive care units. SNAP II Study Group J Pediatr 1998 133 (5)601–607
Pollack MM, Getson PR Pediatric critical care cost containment: combined actuarial and clinical program Crit Care Med 1991 19 (1)12–20
Garber AM, Fuchs VR, Silverman JF Case mix, costs, and outcomes. Differences between faculty and community services in a university hospital N Engl J Med 1984 310 (19)1231–1237
Obladen M, Sachsenweger M, Stahnke M Blood sampling in very low birth weight infants receiving different levels of intensive care Eur J Pediatr 1988 147 (4)399–404
Bifano EM, Curran TR Minimizing donor blood exposure in the neonatal intensive care unit. Current trends and future prospects Clin Perinatol 1995 22(3)657–669
Liu EA, Mannino FL, Lane TA Prospective, randomized trial of the safety and efficacy of a limited donor exposure transfusion program for premature neonates J Pediatr 1994 125 (1)92–96
Wang-Rodriguez J, Mannino FL, Liu E, Lane TA A novel strategy to limit blood donor exposure and blood waste in multiply transfused premature infants Transfusion 1996 36 (1)64–70
Dice JE, Burckart GJ, Woo JT, Helms RA Standardized versus pharmacist-monitored individualized parenteral nutrition in low-birth-weight infants Am J Hosp Pharm 1981 38(10) 1487–1489
Mutchie KD, Smith KA, MacKay MW, Marsh C, Juluson D Pharmacist monitoring of parenteral nutrition: clinical and cost effectiveness Am J Hosp Pharm 1979 36 (6)785–787
Khoshnood B, Lee KS, Corpuz M, Koetting M, Hsieh HI, Kim BI Models for determining cost of care and length of stay in neonatal intensive care units Int J Technol Assess Health Care 1996 12 (1)62–71
Heird WC Parenteral feedingIn: Sinclair JC, Bracken MB, editors. Effective Care of the NewbornOxford: Oxford University Press 1992 141–155
Rubin LP, Richardson DK, Bednarek FJ, OlsenI, McCormick M, SNAP-II Study Group Longitudinal growth in hospitalized VLBW infants: identification of patient characteristics and inter-NICU differences Pediatr Res 1997 41 239A
Pursley D, Al-Aweel I, Gray J, Richardson DK Characterizing practice style in neonatal intensive care Pediatr Res 1998 43 226A
Kahn DJ, Richardson DK, Gray JE, et al Variation among neonatal intensive care units in narcotic administration Arch Pediatr Adolesc Med 1998 152 (9)844–851
Al-Aweel I, Pursley DM, Richardson DK Variations in blood pressure stability and vasopressor use among NICUs and relation to IVH rates Pediatrics 1997 100 492S
Williams S, Whelan A, Weindling AM, Cooke RW Nursing staff requirements for neonatal intensive care Arch Dis Child 1993 68 (5 Spec No)534–538
International Neonatal Network, Scottish Neonatal Consultants, Nurses Collaborative Risk adjusted and population based studies of the outcome for high risk infants in Scotland and Australia. Study Group Arch Dis Child Fetal Neonat Ed 2000 82 (2)F118–F123
Isaacs D, Catterson J, Hope PL, Moxon ER, Wilkinson AR Factors influencing colonisation with gentamicin resistant gram negative organisms in the neonatal unit Arch Dis Child 1988 63(5)533–535
Goldmann DA, Freeman J, Durbin WA Jr Nosocomial infection and death in a neonatal intensive care unit J Infect Dis 1983 147(4)635–641
Urschitz M, Lorenz S, Unterasinger L, Metnitz P, Preyer K, Popow C Three years experience with a patient data management system at a neonatal intensive care unit J Clin Monit Comput 1998 14 (2)119–125
Hegyvary ST, Haussmann RK, Kronman B, Burke M User's Manual for Rush-Medicus Nursing Process Monitoring Methodology Technical Report Chicago: Medicus Systems CorpApril1979
Zupancic JA, Shah A, Richardson DK Prediction of neonatal personnel inputs using severity of illness. A time and motion study Pediatr Res 1999 45 235A
McKee T, Ward T, Isken M From theory to practice — developing decision support tools to manage the cost and quality of obstetrical careIn: 11th Annual Quest for Quality and Productivity in Health Services Conference (Presentation of the Society for Health Systems of the Institute of Industrial Engineers), Washington, DC; Aug 29–Sept 1, 1999
Brooten D, Kumar S, Brown LP, et al A randomized clinical trial of early hospital discharge and home follow-up of very-low-birth-weight infants N Engl J Med 1986 315 (15)934–939
Gray JE, McCormick MC, Richardson DK, Ringer S Normal birth weight intensive care unit survivors: outcome assessment Pediatrics 1996 97 (6 Pt 1)832–838
Rawlings JS, Scott JS Postconceptional age of surviving preterm low-birth-weight infants at hospital discharge Arch Pediatr Adolesc Med 1996 150 (3)260–262
Darnall RA, Kattwinkel J, Nattie C, Robinson M Margin of safety for discharge after apnea in preterm infants Pediatrics 1997 100 (5)795–801
Eichenwald EC, Aina A, Stark AR Apnea frequently persists beyond term gestation in infants delivered at 24 to 28 weeks Pediatrics 1997 100 (3 Pt 1)354–359
Blackwell M, Petit K, McAlmon K, Linton P, Richardson DK Inter-NICU variation in growth, feeding practices and gestational age at discharge (GAdisch) in healthy preterm infants Pediatr Res 1999 45 238A
Wirtschafter DD, Jones KR, Thomas JT Using health care outcomes to improve patient care in the NICU Jt Comm J Qual Improv 1994 20 (2)57–65
Escobar G, Joffe S, Gardner M, Armstrong M, Folck B, Carpenter D Rehospitalization in the first two weeks after discharge from the Neonatal Intensive Care Unit Pediatrics 1999 104 (1)
Jung AL, Bose CL Back transport of neonates: improved efficiency of tertiary nursery bed utilization Pediatrics 1983 71 (6)918–922
Lynch TM, Jung AL, Bose CL Neonatal back transport: clinical outcomes Pediatrics 1988 82 (6)845–851
Bose CL, LaPine TR, Jung AL Neonatal back-transport. Cost-effectiveness Med Care 1985 23 (1)14–19
Phibbs CS, Mortensen L Back transporting infants from neonatal intensive care units to community hospitals for recovery care: effect on total hospital charges Pediatrics 1992 90 (1 Pt 1)22–26
Richardson DK, Reed K, Cutler JC, et al Perinatal regionalization versus hospital competition: the Hartford example Pediatrics 1995 96 (3 Pt 1)417–423
Swanson SC, Naber MM Neonatal integrated home care: nursing without walls Neonatal Netw 1997 16 (7)33–38
Spinner SS, Girifalco RB, Gibson E, Stavis RL, Greenspan JS, Spitzer AR Earlier discharge of infants from neonatal intensive care units: a pilot program of specialized case management and home care. Delaware Valley Child Health Alliance Clin Pediatr (Phila) 1998 37 (6)353–357
American Academy of Pediatrics Committee on Fetus and Newborn. Home phototherapy Pediatrics 1985 76 (1)136–137
Als H, Lawhon G, Duffy FH, McAnulty GB, Gibes-Grossman R, Blickman JG Individualized developmental care for the very low-birth-weight preterm infant. Medical and neurofunctional effects JAMA 1994 272 (11)853–858
Buehler DM, Als H, Duffy FH, McAnulty GB, Liederman J Effectiveness of individualized developmental care for low-risk preterm infants: behavioral and electrophysiologic evidence Pediatrics 1995 96(5 Pt 1)923–932
Garland JS Developmental care for very low-birth-weight infants [letter; comment] JAMA 1995 273 (20)1575discussion 1577–1578
Westrup B, Kleberg A, von Eichwald K, Stjernqvist K, Lagercrantz H A randomized, controlled trial to evaluate the effects of the newborn individualized developmental care and assessment program in a Swedish setting Pediatrics 2000 105 (1 Pt 1)66–72
Mitchell-DiCenso A, Guyatt G, Marrin M, et al A controlled trial of nurse practitioners in neonatal intensive care Pediatrics 1996 98 (6 Pt 1)1143–1148
Rich EC, Gifford G, Dowd B The effects of scheduled intern rotation on the cost and quality of teaching hospital care Eval Health Prof 1994 17 (3)259–272
Perlmutter DF, Suico C, Krauss AN, Auld PA A program to reduce discharge delays in a neonatal intensive care unit Am J Managed Care 1998 4 (4)548–552
Stinson R, Stinson P On the death of a baby Atlantic MonthlyJuly1979 64–72
Stolz JW, McCormick MC Restricting access to neonatal intensive care: effect on mortality and economic savings Pediatrics 1998 101 (3 Pt 1)344–348
Silverman WA Overtreatment of neonates? A personal retrospective Pediatrics 1992 90 (6)971–976
Harrison H The principles for family-centered neonatal care Pediatrics 1993 92 (5)643–650
Annas GJ Asking the courts to set the standard of emergency care — the case of Baby K N Engl J Med 1994 330 (21)1542–1545
Paris JJ, Crone RK, Reardon F Physicians' refusal of requested treatment. The case of Baby L N Engl J Med 1990 322 (14)1012–1015
Paris JJ, Schreiber MD Physicians' refusal to provide life-prolonging medical interventions Clin Perinatol 1996 23 (3)563–571
Kotter J Why transformation efforts fail Harv Bus Rev 1995 73 61–72
Escobar GJ, Fischer A, Kremers R, Usatin MS, Macedo AM, Gardner MN Rapid retrieval of neonatal outcomes data: the Kaiser Permanente Neonatal Minimum Data Set Qual Manage Health Care 1997 5 19–33
Acknowledgements
This project was supported by a sabbatical grant from the Burroughs Wellcome Fund while D. K. Richardson was visiting the National Perinatal Epidemiology Unit in Oxford England. J. A. F. Zupancic is funded by the Medical Research Council, Canada.
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This project was supported by a sabbatical grant from the Burroughs Wellcome Fund while D. K. Richardson was visiting the National Perinatal Epidemiology Unit in Oxford England. J.A.F. Zupancic is funded by the Medical Research Council, Canada.
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Richardson, D., Zupancic, J., Escobar, G. et al. A Critical Review of Cost Reduction in Neonatal Intensive Care II. Strategies for Reduction. J Perinatol 21, 121–127 (2001). https://doi.org/10.1038/sj.jp.7200501
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DOI: https://doi.org/10.1038/sj.jp.7200501
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