Dataset Information

Assessing Neonatal Intensive Care Unit Structures and Outcomes Before and During the COVID-19 Pandemic: Network Analysis Study.

ABSTRACT:

Background

Healthcare organizations (HCOs) adopt strategies (e.g., physical distancing) to protect clini-cians and patients in intensive care units (ICUs) during the COVID-19 (C19) pandemic. Many care activities physically performed before C19 have been moving to virtual systems during the C19. The transitions from the physical to the virtual settings can interfere with collaboration structures in the ICU, which may impact clinical outcomes. Understanding the differences can help HCOs identify challenges when transitioning physical collaboration to the virtual in the post-C19 era.

Objective

This study aims to leverage network analysis to determine the changes in neonatal ICU (NICU) collaboration structures from pre- to intra-C19.

Methods

In this retrospective study, we applied network analysis to the utilization of electronic health records (EHRs) of 712 critically ill neonates (386 pre-C19 and 326 intra-C19, excluding those with C19 infection) admitted to the NICU of Vanderbilt University Medical Center (a major academic medical center at Nashville, Tennessee, USA) between September 1, 2019, and June 30, 2020 to learn collaboration between clinicians. We characterized pre-C19 as September through December of 2019 and intra-C19 as March through June of 2020. These two groups were compared using patients' clinical characteristics, including their age, sex, race, length of stay (LOS), and discharge dispositions. We leveraged the actions committed to the EHRs of patients by clinicians to measure clinician-clinician connections. We characterized a collabora-tion relationship (tie) between two clinicians as they performed actions to EHRs of the same patient within the same day. Upon the definition of collaboration relationship, we built pre- and intra-C19 networks. We used three sociometric measurements, including eigenvector centrali-ty, eccentricity, and betweenness, to quantify a clinician's leadership, collaboration difficulty, and broad skillsets in a network, respectively. We assessed the extent to which the eigenvector centrality, eccentricity, and betweenness of clinicians, in pre- and intra-C19 networks, are sta-tistically different using Mann-Whitney U tests at the 95% confidence level.

Results

Our analysis results showed that the collaboration difficulty increased from pre- to intra-C19 (median eccentricity: 3 vs. 4, p <.001). In addition, nurses had reduced leadership (median ei-genvector centrality: 0.183 vs. 0.087, p <.001), and neonatologists who have broader skillsets cared for a wider spectrum of patients in the NICU structure during the C19 pandemic (median betweenness centrality: 0.0001 vs. 0.005, p <.001). The pre- and intra-C19 patient groups shared similar distributions in sex (~0 difference), race (4% difference in White, and 3% dif-ference in African American), LOS (interquartile range difference in 1.5 days), and discharge dispositions (~0 difference in home, 2% difference in expired, and 2% difference in others). There were no significant differences in the patient demographics and outcomes between the two groups.

Conclusions

Management of NICU patients typically requires multidisciplinary care teams. Understanding collaboration structures can provide fine-grained evidence to potentially refine or optimize ex-isting teamwork in the NICU.

Clinicaltrial

SUBMITTER: Mannering H

PROVIDER: S-EPMC8530253 | biostudies-literature |

REPOSITORIES: biostudies-literature

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