Introduction of Microsystems in a Level 3 Neonatal Intensive Care Unit

Study Overview
=================
Brief Summary
-----------------
The advancement in life-saving technologies and clinical expertise in the care of extremely premature infants, have resulted in the development of large neonatal intensive care units (NICU). It has been suggested that reconstruction of megaunits of neonatal intensive care to smaller care units with specific patient population and clinical team providers will be essential to maintain optimal teamwork, quality of care and patient outcome. Despite the growing knowledge around the need for reconstruction of large NICUs to smaller units of care, there is no evidence regarding the safety and efficacy of microsystem model of care on the key aspects of health care. At the McMaster Children's Hospital (MCH), we planned a change from standard model of care to the microsystem model of care and therefore we aimed to prospectively assess the effect of this organizational change on the variable aspects of health care. A working group met weekly to formulate the implementation planning, to review the adaptation and adjustment process and to ascertain the quality of implementation following the initiation of the microsystem model. The study was retrospectively registered.

Official Title
-----------------
Introduction of Microsystems in a Level 3 Neonatal Intensive Care Unit - an Interprofessional Approach

Conditions
-----------------
Stress, Psychological, Inflammatory Bowel Diseases, Lung Diseases, Infant Nutrition Disorders, Eye Manifestations, Neurodevelopmental Disorders

Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion criteria: All preterm and term infants admitted to McMaster Children's Hospital NICU Exclusion criteria: no exclusion criteria
Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------
What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change of stress level of Health Care Professional - Salivary cortisol (ng/dL) |  | once every week, up to 3 month corrected age | 
| Change of stress level of Parents - Salivary cortisol (ng/dL) |  | once every week, up to 3 month corrected age | 
| Change of stress level of Patients - Salivary cortisol (ng/dL) |  | once every week, up to 3 month corrected age | 
| Length of stay - days |  | up to 3 month corrected age | 
| Incidence of necrotizing enterocolitis |  | up to 3 month corrected age | 
| Incidence of retinopathia of prematurity |  | up to 3 month corrected age | 
| Incidence of bronchopulmonary dysplasia |  | up to 3 month corrected age | 
| Incidence of sepsis |  | up to 3 month corrected age | 
| Duration of mechanical ventilation - days |  | up to 3 month corrected age | 
| Time of feed initiation - days |  | up to 3 month corrected age | 
| Time to full feed - days |  | up to 3 month corrected age | 
| Number of days with parenteral nutrition |  | up to 3 month corrected age | 
| Bayley scale - Psychomotor Developmental Index |  | up to 3 month corrected age | 
| Bayley scale - Mental Developmental Index |  | up to 3 month corrected age | 
| Number of changes in the primary health care professionals |  | up to 3 month corrected age | 
| Noise level (decibel) |  | up to 3 month corrected age | 
| use of resources (lab tests, X-rays, microbiological tests) | number of procedures | up to 3 month corrected age |