Multiprofessional cross-site working between a level 1 and a level 3 neonatal unit: a retrospective cohort study.

Objective: To assess the association of short-term neonatal outcomes with cross-site working of multiple healthcare professional teams between a level 3 and a level 1 neonatal unit.

Design: Retrospective cohort study.

Setting: A level 1 neonatal unit in London.

Patients: All infants admitted to the neonatal unit, between 2010 and 2021.

Interventions: The clinical service was rearranged in 2014 with the introduction of cross-site working between the level 1 unit and a level 3 unit of neonatal doctors, nurses and allied healthcare professionals.

Main Outcome Measures: Admission of infants with a temperature less than 36°C, length of stay and time to first consultation by a senior team member.

Results: A total of 4418 infants were admitted during the study period. The percentage of infants delivered at a gestation below 32 weeks was higher in the pre-cross-site period (8.9%) compared with the cross site period (3.6%, p<0.001). The percentage of infants with an Apgar score less than 8 at 10 min was higher in the pre-cross-site period (6.2%) compared with the cross-site period (3.4%, p=0.001). More infants were admitted with a temperature less than 36°C in the pre-cross site period (12.3%) compared with the cross site period (3.7%, p<0.001). The median (IQR) duration of time to first consultation by a senior team member was higher in the pre-cross-site period (1 (0.5-2.6) hours) compared with the cross-site period (0.5 (0.2-1.3) hours) (p<0.001). The median (IQR) length of stay was 4 (2-11) days in the pre-cross-site period and decreased to 2 (1-4) days in the cross-site period (p<0.001).

Conclusions: Cross-site working was associated with lower rates of admission hypothermia, shorter duration of stay and earlier first senior consultation.