Table 3

Factors implicated for complaint against neonatal units

Factors implicated in cause of errorsStudy
Inadequate supervision of junior colleagues in resuscitation setting—delay in senior arrivingAshcroft17
Lack of training of junior doctors in resuscitationAshcroft17
Culture of work and hierarchy resulting in a fear of asking for helpAshcroft17
Errors due to lack of adequate on site expert medical assistance (generally on shifts after 5 pm or over the night the shift)Ashcroft17
Not adequately listening to maternal or family concernsHawdon et al19
Reduced access to proper equipment in a timely fashion for example, lab testing of glucose versus near patient testing devicesHawdon et al19
System failures for example, lack of cots in neonatal unit or on the ward contributing to delays in initiating time critical treatment (phototherapy)Rennie et al20
Lack of training in communicationNguyen et al13
Staff shortage and high workloadAshcroft17
Human factors—for example, tirednessAshcroft17