Due to capacity problems, about 600 babies have to be moved to another Neonatal Intensive Care Unit (NICU) every year. Researchers from the University of Twente's CHOIR research centre, the Amalia Children's Hospital Nijmegen and the Emma Children's Hospital Amsterdam investigated an innovative solution. By deploying NICU nurses flexibly within the national NICU network, the number of neonatal transports can potentially be reduced by as much as 70% – a reduction of at least one patient transport per day.
The good news is that in the Netherlands as a whole, we have sufficient capacity to provide this critical form of care. But currently, babies are often moved when an NICU runs out of capacity. In addition to a lot of logistical hassle, this entails health risks for the child and an increased distance to the parents' place of residence. "The physical capacity of NICUs is usually not the problem, but the shortage of specialised nurses," says Gréanne Leeftink, first author of the study.
Flexibility prevents patient movements
The research, published in Health Care Management Science, shows that moving nurses instead of babies can prevent a majority of these transports. The researchers analysed various scenarios. "With a little bit of flexibility in staff deployment, a large part of patient movements can be prevented," says Leeftink. This method appears to be very effective, especially in the most urbanised region of the Netherlands: de Randstad.
To improve the use of the available care capacity, only 15% of the nurses need to be available at multiple locations for part of their time. In the end, it only concerns 3-4% of the services. "Through cooperation and flexible deployment, we can improve our use of the available care capacity," says Leeftink. The researchers argue for a pilot project to test the feasibility in practice. Such a system can not only improve the quality of care but also reduce the burden on parents and care staff.
Different strategies
To optimally organise the flexible deployment of nurses, the researchers investigated various strategies. The approach in which nurses can be deployed to all NICUs proved to be the most effective in reducing transports but also requires the most flexibility from the staff.
An alternative strategy pairs NICUs together in pairs, so nurses only need to move between two locations. Although this method resulted in slightly less transport reduction, it offers advantages such as shorter travel times and more stability for the staff.
Learn more
The research builds on the graduation work of UT alumna Kimberley Morris, who won the Graduation Award of the BMS faculty in 2022 on this theme. Dr. Gréanne Leeftink, associate professor within the CHOIR research group (TechMed Center), collaborated with Prof. Erwin Hans, professor of operations management and co-founder of CHOIR, and doctors Tim Antonius of the Amalia Children's Hospital Nijmegen and Willem de Vries of the Emma Children's Hospital Amsterdam to further expand the study.
Their findings have been published in the scientific journal Health Care Management Science under the title 'Inter-organizational pooling of NICU nurses in the Dutch neonatal network: a simulation-optimization study'. The article is open access and available online.
