134 6 CHAPTER 6 6 | GOODARZI et al. recommended pediatric consultation after every MSAF, whereas in the neonatal protocol, consultation was only recommended in case of poor/bad neonatal vital signs in addition to MSAF. 3.4 | Intradepartmental variation: within a single obstetric or neonatal department We found noncorresponding recommendations within the protocols of 35 departments. The most common reason for noncorrespondence (74%) concerned the indication for pediatric consultation or neonatal admission. Within eight protocols ― LGA (n = 3), SGA (n = 1), MSAF (n = 2), VE (n = 1), FE (n = 1) ― the test cutoff values did not correspond. For example, an LGA protocol from an obstetric department described within the same document referral to the pediatrician when birthweight was >4000 grams and when birthweight was >95th percentile. Type of referral and test cutoff values did not correspond in one MSAF, one VE, and one FE protocol. Type of referral and pediatrician's attendance at birth did not correspond in one VE and one FE protocol. 3.5 | Regional and interdepartmental variation in referral threshold We found variation in threshold for neonatal referral to the pediatrician between departments and between regions (Table 6). The categories for referral threshold are presented in Supplement 4. Overall, the obstetric departments' protocols and the protocols from hospitals located in the northern and southern region contained the highest number of recommendations with a low threshold, leading to a higher referral rate. The neonatal department's protocols and the protocols from hospitals in the eastern region contained most of the recommendations with a high threshold, leading to a lower referral rate. Type of department Total O N n, % n, % n, % Protocols 420 (100) 189 (100) 231 (100) Date Mentioned 87 (21) Range: 2011–2020 49 (26) Range: 2011–2019 38 (16) Range: 2017–2020 Not mentioned 333 (79) 140 (74) 193 (84) Type of protocol Hospital only 110 (26) 49 (26) 61 (26) Regional 36 (9) 24 (13) 12 (5) Not mentioned 274 (65) 116 (61) 158 (68) Disciplinary collaboration Monodisciplinary 34 (8) 10 (5) 24 (10) Multidisciplinary within hospital 43 (10) 16 (8) 27 (12) Multidisciplinary within MCC 15 (4) 7 (4) 8 (3) Not mentioned 328 (78) 156 (83) 172 (74) References Scientific literature 18 (4) 10 (5) 8 (3) Other guidelines 71 (17) 30 (16) 43 (17) Scientific literature and other guidelines 41 (10) 14 (7) 25 (11) Professional consensus 9 (2) 3 (2) 6 (3) Not mentioned 281 (67) 132 (70) 149 (62) Abbreviations: N, neonatal department; O, obstetric department. TABLE 3 Characteristics of the protocols by type of department (n, %) 1523536x, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/birt.12690 by Vrije Universiteit Amsterdam, Wiley Online Library on [14/11/2022]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
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