Interns order more tests than residents in the NICU

C. H. Griffith, J. F. Wilson, N. S. DeSai, E. C. Rich

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Much of neonatal tertiary care is provided by housestaff, but little is known of the effects of housestaff experience on patient outcomes in the Neonatal Intensive Care Unit (NICU). We hypothesized that less experienced interns on call in the NICU would order more tests on the less severely ill infants than more experienced residents on call. We collected data prospectively on all infants admitted to our NICU from 7/93-6/94 who were designated 1:1 (one infant for one nurse) or 2:1 status by the Nurses Acuity Scale. The severity-of-illness of each infants was calculated daily using the Neonatal Therapeutic Intervention Scoring System (NTISS). The less severely ill infants were defined as infants with NTISS scores less than 14. Four housestaff rotate on our NICU service each month, with either an intern or a resident on call by themselves each night. The outcome of interest was the number of tests ordered by the houseofficer on call: arterial blood gases, x-rays, and electrolytes. Nine pediatric residents and six interns rotated on the NICU service in the 1993-1994 academic year. Data was collected on 66 of the less severely ill infants, comprising 211 infant-days. Residents on call ordered tests on those infants 40% of the time, versus 59% for interns (p=0.009 by Chi-Square). Controlling for infant characteristics (birthweight, APGARS, ventilated or not, severity-of-illness) with multiple logistic regression, whether an infant was cared for by an intern or resident was an independent predictor of whether a test were ordered or not on that infant (O.R. 2.156; 95% C.I. 1.21-3.85; p=0.009). We conclude that interns order more tests on less severely ill infants in the NICU than residents. Further research will need to determine if housestaff experience affects other neonatal outcomes.

Original languageEnglish
Pages (from-to)13A
JournalJournal of Investigative Medicine
Issue number1
StatePublished - 1996

ASJC Scopus subject areas

  • General Biochemistry, Genetics and Molecular Biology


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