263 - Resident Rounding Teams in the NICU: Education and Patient Outcomes

Poster Number: 263
Publication Number: 263.330

Bianca E. LoVerde, Bianca LoVerde, Pittsburgh, PA, United States

Background: Neonatal intensive care unit (NICU) training hours for pediatric residents have been sladhed by 75% over the last three decades. Concurrently, invasive procedures declined and non-physician learners surged, further diluting educational experiences. Although patient care was not affected, NICU resident education satisfaction, procedure attempts, and competency decreased nationally.

Objective: To determine if a resident rounding team impacts educational satisfaction, improves NICU knowledge, and increases procedure attempts for pediatric residents without affecting patient outcomes.

Design/Methods: This study took place at UPMC Magee-Womens Hospital, a 77-bed level 3 academic NICU in Pittsburgh, PA from July 2019-June 2020. The preceding 3 academic years served as control. Interventions included: (1) rotation structure, (2) resources, and (3) didactics. We analyzed resident rotation evaluations, procedure logs, and in-training exam scores for educational outcomes for interns on their NICU rotation (n=40). We performed a chart review for all neonates admitted to the NICU during the study period for demographics, acuity, and outcomes. Chi-square/Fischer’s Exact tests compared discrete characteristics, and Kruskal-Wallis/1-way ANOVA compared continuous characteristics.

Results: Overall learning experience increased from 4.2 to 4.53 (p < 0.01) on a 5-point scale, and satisfaction with autonomy increased from 3.98 to 4.26 (p=0.03). Resident report of bedside teaching improved from 89 to 100% (p < 0.001). Residents did not report significant changes in feedback, and in-training exam scores did not improve. Procedure numbers remained low throughout the control and study period (Table 1), and no statistical analysis was possible. Patient demographics were similar between control, resident, and NPP teams (Table 2). Compared to controls, use of mechanical ventilation decreased (p < 0.001) while pneumothoraxes increased (p < 0.01) with no difference between the resident and NPP team. This reflects a unit protocol change around the same time. Patient outcomes were unchanged (Table 3), except for use of nasal cannula, again reflecting unit protocols. Although not statistically significant, residents did adhere to antibiotic protocols more closely.Conclusion(s): A resident team in the NICU improved satisfaction with autonomy, learning experience, and bedside teaching while maintaining patient outcomes, but did not impact procedure attempts or tested knowledge. Resident teams are a feasible way to improve the educational environment of the NICU, but other avenues are required to address procedural experience.
Table 1. Number of procedures reported by all residents per year
Table 2. Patient demographics for neonates admitted to the NICU*Acuity score = average number of listed diagnoses each infant had
Abbreviations: NEC (necrotizing enterocolitis); HIE (hypoxic ischemic encephalopathy); IVH (intraventricular hemorrhage); pHTN (pulmonary hypertension); Pneumo (pneumothorax); Ex Txf (exchange transfusion), ROP (retinopathy of prematurity); CHD (congenital heart disease); Micro (micropremie); Tube (mechanical ventilation)