Critical newborn transport in Veneto Region: models and simulation

Women pregnancy may generally present either a physiological or a pathological behaviour, which obviously influence the newborn health conditions. Newborns may require one of the following assistance levels: first level assistance, which supplies generic neonatal assistance; second level assistance, which supplies neonatal pathology assistance (incubator); third level assistance, which supplies neonatal intensive care by a specialized neonatal intensive care unit (ventilated incubator). The first level assistance is supplied in most hospital centres, the first and the second level assistance in some specialized centres and all three level one in few highly specialized centres. Every pregnant woman is generally admitted to a birth centre where the assistance level is appropriate to the expected birth complications. Anyway sometimes newborn conditions may appear more severe than expected, so that the resources at disposition in the birth centre are not sufficient and an urgent transfer to a higher level centre is required (2-2.5% of newborns). Initial cares supplied to a newborn represent one of the key factors which determine its survival; critical newborn transport is an integral part of such cares. The procedure starts when the birth hospital identifies the newborn emergency situation. Newborn transport procedure requires a transport team activation at the service base, its movement to a first or second level centre, the newborn stabilization, its transportation to the chosen third level centre, a back transport of the team to the service base. The Veneto Region has about 45,000 births per year in 41 birth centres and 8 third level birth centres; two critical newborn transport services are working, in Padova and in Verona, each one serving a well defined part of the region. We built up a flexible and extendable simulation model, coded in MicroSaint, to analyse whether resources at disposition are sufficient for what concerns newborn transport and newborn admissions in the region, both in current situation and in possible future changed ones. The model results include transport teams utilization, transport team mean process time between call and hospital admission and waiting time due to busy service. While transport service performance reveals sufficient, strong suggestions for third level hospital resources increase are evident.