Neonatal Services Performance Indicators

Introduction

The department's neonatal performance indicators focus on measuring:

• The system's capacity to meet demand for neonatal care, which fluctuates between periods of extreme pressure and periods of reduced demand;
• Access to neonatal services and organisational capability to meet demand.

These indicators apply to Level 2 and Level 3 hospitals with neonatal services. They do not apply to Level 1 maternity services with nurseries.

The neonatal service system is an integrated system which seeks to match the level of care provided to the place of care. Infants requiring intensive care receive it in one of the four Level 3 hospitals with a neonatal intensive care unit (NICU). Infants who require a lower level of care, receive it in one of the Level 2 hospitals with a special care nursery (SCN) or in the SCN of one of the Level 3 hospitals.

In some instances, it is necessary to transfer babies to ensure they receive the most appropriate level of care. Although in-utero transfer is preferable to neonatal transfer, this is not always possible, either because the infant's birth or illness has been unexpected or the particular service required is not available at the hospital of birth. Approximately 1,000 newborns are transferred to Level 3 NICUs for intensive care each year (up-transfer). Infants are also transferred back to Level 2 SCNs for convalescent care when they no longer require high level care (down-transfer). Down-transfers are important in ensuring infants can be cared for in a hospital closer to home as well as in freeing up Level 3 nursery beds.

NEO 1 Percentage of occupied neonatal beds

This indicator aims to identify whether the neonatal service system is able to meet fluctuating demand.

For Level 3 hospitals, infants occupying neonatal beds are divided into ventilated and non-ventilated infants. A ventilated infant is a baby who is either receiving mechanical ventilation through an endotracheal tube or is treated with Continuous Positive Airway Pressure (CPAP) by any route.

Ventilation status does not apply to Level 2 hospitals.

Reporting Performance

Data Source of the Numerator

The Newborn Emergency Transport Service (NETS) collects bed census information on a daily basis from all Level 3 and Level 2 hospitals with neonatal services via the central Victorian Perinatal Information Centre (VicPIC) database. Hospitals are required to directly input bed status information onto this database on a daily basis and to update the bed status whenever a change occurs. Hospitals should ensure that bed status data is accurate at all times.

Level 3 Hospitals

The numerator is based on the average number of occupied ventilated and non-ventilated beds for the quarter as entered on VicPIC. All entries are taken into account in calculating the average number of occupied beds.

Level 2 Hospitals

The numerator is based on the average number of occupied special care cots for the quarter as entered on VicPIC. All entries are taken into account in calculating the average number of occupied beds.

NETS will forward this information to the department on a monthly basis. No other action is required by hospitals.

Data Source of the Denominator

Level 3 Hospitals

The denominator is based on each hospital's usual operating number of ventilated and non-ventilated beds as agreed between the health service and the department.

Level 2 Hospitals

The denominator is based on each hospital's usual operating number of special care beds as advised to the department in 2005 (or updated as a result of subsequent advice).

Hospitals are required to advise the department in writing if the usual operating number of beds changes at any time.

NEO 2 Percentage of days on which a level 2 neonatal unit is able to accept a down-transfer of a convalescent infant

This indicator aims to identify whether all neonates can be admitted to a Level 2 nursery when required.

Reporting Performance

Level 2 hospitals

'Able to accept a down-transfer' is based on the Level 2 nursery declaring itself as being “OPEN” on the VicPIC website.

NETS will forward this information to the department on a monthly basis. No other action is required by hospitals.

Level 3 Hospitals are not required to report on this indicator.

NEO 3 Number of Level 3 neonatal overflow transfers

This indicator aims to identify whether newborn infants can be admitted to a Level 3 nursery when required.

An overflow transfer is the transfer of an infant requiring intensive care between Level 3 nurseries due to a neonatal intensive care bed not being available at the referring hospital. Most Level 3 hospitals with neonatal intensive care facilities have the capability to provide the majority of intensive care services. However, certain hospitals provide specialty neonatal services, such as management of surgical problems. A transfer occurring because a specialty is not available at a hospital is not considered to be an overflow transfer.

Reporting Performance

Level 3 Hospitals

NETS maintains a record of the number of neonatal intensive care transfers between Level 3 units as well as the reason for the transfer. This information will be forwarded to the department within the first week of the following month. No other action is required by hospitals.

Level 2 Hospitals are not required to report on this indicator.

Contact: For general enquiries Tel. (03) 9096 7798

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