| dc.description.abstract | Background: There is an inherent tension in neonatalservices between the efficiency and specialised
care that comes with centralisation, and the provision of localservices with associated ease of access
and community benefits. This study builds on previous work in the SW of England to address these
issues at a national scale.
Objectives: To develop an analytical framework to addresses key issues of neonatal service
configuration in England. To investigate visualisation tools to facilitate communication of findings to
stakeholder groups. To assess parental preferences in relation to service configuration alternatives.
Main outcome measures: Ability to meet nurse staffing guidelines, volumes of units, costs, mortality,
number and distance of transfers, travel distances and times for parents.
Design: Descriptive statistics, location analysis, mathematical modelling, discrete event simulation
and economic analysis. Qualitative methods to interview policy makers and parents. A parent
advisory group supported the study.
Setting: NHS neonatal services across England.
Data: Neonatal care data sourced from the National Neonatal Audit Database. Information on
neonatal units from the National Neonatal Audit Programme. Geographic and demographic data
from Office of National Statistics. Travel time data via a geographic information system. Birth data
from Hospital Episode Statistics. Parental cost data via survey data.
Results: Location analysis shows that to achieve 100% of births in units with at least 6,000 births per
year, the number of birth centres would need to be reduced from 161 to approximately 72, with
more parents travelling over 30 minutes. The maximum number of Neonatal Intensive Care Units
(NICUs) needed to achieve 100% of very low birth weight (VLBW) infants attending high volume units
(at least 100 VLBW admissions per year) is 36 with existing NICUs, or 48 if NICUs are located wherever
there is currently a neonatal unit of any level.
Mortality modelling shows birth for very preterm infants in high volume hospitals reduces mortality
(a conservative estimate of 1.2 percentage point lower risk) relative to other hospitals. It is currently
not possible to estimate the impact of mortality for infants transferred into NICUs.
Cost modelling shows that length of stay (LOS) following birth in high volume hospitals is nine days
longer and costs £5,715 more than birth in another neonatal unit. In addition, the incremental cost
per neonatal life saved is £460,887 which is comparable to other similar life‐saving interventions.
[iii]
Analysis of parent costsidentified: unpaid leave entitlement, food, travel, accommodation, baby care
and parking as key factors. The qualitative study suggested central concerns were: baby and mother’s
health, communication by medical teams, and support for families.
Limitations: We were unable to model the following factors due to paucity of data: morbidity
outcomes, impact of transfers, and the maternity/neonatal service interface.
Conclusions: We developed an evidence‐based framework to inform the configuration of neonatal
services and model system performance from perspectives of both service providers and parents.
Future work: To extend the modelling to encompass the interface between maternity and neonatal
service | en_GB |
