Neonatal units face overload, cot shortage
Over-run units caring for New Zealand’s sickest newborns urgently need more resources, a review has found.
Neonatal intensive care unit (NICU) staff around the country report feeling overworked dealing with the high occupancy rates, which have led district health boards to add extra cots or to transfer babies out of region to receive care.
The long-awaited national review of neonatal care, the first since 2008, was commissioned by the Ministry of Health and led by the New Zealand Newborn Clinical Network.
Stuff revealed last year that the ministry received the draft in March 2019.
Delays releasing it prompted criticism from the likes of National Party health spokesman Michael Woodhouse, who said not acting on its recommendations could put babies’ lives at risk.
The ministry quietly uploaded the review to its website yesterday – a day after the Government announced billions of dollars of spending on infrastructure projects, including funds to upgrade neonatal care facilities at the Counties Manukau, Hutt Valley and Capital & Coast district health boards.
All NICU levels consistently operated above capacity between 2012 and 2017, the review found. In 2017, occupancy exceeded 85 per cent (the level considered safe) for 98 per cent of days in level 3 units, which provide the highest level of care to extremely premature and sick babies.
To manage demand, DHBs were putting in additional cots above their resourced numbers. If there was no space, babies were transferred to other areas.
About a quarter of babies requiring level 3 care were cared for in units away from where they lived.
Some staff surveyed for the review described overwhelming workloads where ‘‘one admission can tip us over’’, and expressed concern about the level of care they were able to provide.
‘‘There are often occasions where all nurses will have extremely unsafe workloads and admissions continue to come in,’’ one registered nurse said.
‘‘I have told my manager that our stress levels when there are high patient volumes, especially if they are sick, often feels like we are all treading water and we are seconds away from drowning.’’
Between 2004 and 2018, the number of resourced cots nationwide increased from 319 to 342. The survey found a shortage of cot space was always or often a problem for 77 per cent of respondents in level 3 units, and 64 per cent for staff across all NICU levels.
Sustained high occupancy levels placed pressure on staff, the review found, and a high proportion of the workforce considered they were overworked. Most staff considered they provided quality care but many also noted the challenges of doing so when occupancy rates were too high.
‘‘It is disheartening not to be able to provide the best care every time due to workload and staff shortages,’’ one survey respondent said.
Another noted it was unfair on parents and meant ‘‘I go home feeling stink’’.
The review said the most important priority was the need to increase resourcing to bring occupancy levels down to 85 per cent most of the time. This included more cots, staff time and specialised equipment.
Other recommendations included improving the national co-ordination of cot space, and improved communication and information flow through maternity to newborn care.
The NICU workforce was an ageing one (of the survey respondents, 43 per cent were aged over 50), and the review noted that in the future it could be difficult to attract staff.
Health Minister David Clark said $16 million had been put towards the neonatal upgrades. Neonatal intensive care had suffered from underfunding under the previous Government, he claimed, and the report was an ‘‘important piece of work’’ for identifying how to improve care ‘‘for our most vulnerable and precious patients’’.