Variatie in aanmelding van vrije plaatsen door neonatale intensive-careafdelingen en consequenties voor doelmatigheid, rechtvaardigheid en kwaliteit en zorg

Objective. To determine whether the national information system on available beds in neonatal intensive care units (NICUs) leads to fair distribution and good efficiency and quality of care. Setting. Two out of the ten NICUs in the Netherlands. Design. Descriptive. Methods. Data were gathered through observations and 18 interviews with among others neonatologists, gynaecologists and paediatricians. Another 19 doctors were interviewed by phone after a patient they had referred was refused. Interviews were analysed by means of Kwalitan, a computer programme for analysis of qualitative research. Results. When a patient could not be admitted in his own region, the information system was often used to find out which NICUs had a bed available. Sometimes a NICU was called that, according to the information system, did not have a place available. Reasons were: the information was not up to date and not all available beds were reported. This last reason had to do with the wish to keep a bed free for patients from the NICU's own region. Because most doctors were aware of this, they sometimes negotiated about beds, which was time-consuming. Conclusion. The information system was used often, but was working below optimal level, resulting in diminished efficiency. This was primarily caused by the priority given to patients of the own region, which had to do with quality of care considerations. The existing variation in use of the priority policy deserves attention from the viewpoint of procedural justice.