063 - Teamwork Duration and Agreement in Neonatal Intensive Care Unit (NICU) Respiratory Care Practice Preferences

Publication Number: 63.6719

Sofia Gnecco, Beth Israel Deaconess Medical Center, Boston, MA, United States; Helen Healy, Harvard Medical School, Boston, MA, United States; Katharine Johnson, Pediatrix Medical Group, San Antonio, San Antonio, TX, United States; David Riley, Texas Christian University School of Medicine, Westlake, TX, United States; Cheryl Motta, Pediatrix Medical Group, San Antonio, TX, United States; Mary Wearden, North Central Baptist Hospital, San Antonio, TX, United States; Meghali Singhal, Pediatrix, Austin, TX, United States; Emily Whitesel, Boston Children's Hospital, Newton Highlands, MA, United States; John Zupancic, Beth Israel Deaconess Medical Center, Boston, MA, United States; Munish Gupta, Beth, Boston, MA, United States; Kaashif A. Ahmad, Pediatrix Medical Group, Houston, TX, United States

Background: Minimizing practice variation is theorized to improve quality of care. Neonatal respiratory care is multidisciplinary and often lacks clear evidence-based practice. Factors influencing provider agreement on respiratory care practices in neonatal intensive care units (NICUs) remain underexplored, warranting further investigation to reveal insights into the human side of change.

Objective: To evaluate the association between providers’ average employment length in a specific NICU (AEL-N), as indicator of teamwork duration, and agreement on respiratory care practice preferences for preterm infants.

Design/Methods: The Neonatology Survey of Interdisciplinary Groups in Healthcare Tool (NSIGHT), a vignette-based survey measuring respiratory care practice preferences in NICUs, was conducted in 9 Texas NICUs, including 3 Level III and 6 Level IV units. Physicians, nurses (RNs), advance practice providers (APPs), and respiratory therapists (RTs) participated. Providers reported employment length in the current unit and lifetime employment duration using predefined categories. They used a 5-point Likert Scale to indicate practice preferences between two options in response to vignette-style questions. Six vignettes were common to all unit surveys (Table 1). Agreement by unit and discipline across all vignettes was evaluated using standard deviation (SD). Lower SDs reflected greater agreement. Relationship between AEL-N and agreement was assessed by simple and multiple linear regression, adjusting for average employment length - lifetime (AEL-L).

Results: A total of 607 responses were obtained from 9 NICUs. RNs were the largest group of participants (57%). Figure 1 shows the correlation of AEL-N with agreement across all vignettes, both for all disciplines combined and by individual discipline, using simple linear regression. For RNs, each additional year of AEL-N significantly reduced agreement (-0.03, 95% CI -0.01 to -0.05). Neonatologists showed a similar trend, while RTs exhibited an opposing trend; however, neither was statistically significant. For all disciplines combined, AEL-N was not correlated with agreement. Adjusting for AEL-L had no significant impact on results (Table 2).

Conclusion(s): AEL-N showed no significant association with agreement on respiratory care practices among all disciplines. However, RNs showed a significant increase in agreement with longer AEL-N, suggesting teamwork duration may influence unit culture, though this effect may vary by discipline. Further studies are needed to explore discipline-specific impacts of teamwork duration on agreement in respiratory care practice preferences.

Figure 1. Simple linear regression of providers’ average employment length in their current NICU (AEL-N) and agreement (measured by standard deviation) across 9 NICUs, both for all disciplines and by individual discipline.
*Each dot represents a different NICU.

Table 1. Neonatology Survey of Interdisciplinary Groups in Healthcare Tool (NSIGHT): Six vignette questions common to the nine neonatal intensive care unit (NICU) surveys.


Table 2. Linear Regression Analysis: Association between providers' average employment length in a specific NICU (AEL-N), as indicator of teamwork duration, and agreement.
*Adjusting for average employment length - lifetime (AEL-L)/ Italics: significant values (p <0.05).