The Potential Cost of Waiting to Name the Baby

Of all the medical mistakes that could be made in the first hours of a newborn’s life, few lay people would think to attribute any of them to a delay in naming the infant. But neonatologists (doctors who treat ill or premature newborns) know that the unnamed wee ones under their care are more likely to be on the receiving end of a medical error.

When a baby is born and the parents are still dithering about what to call him or her, hospitals use a generic gender descriptor on the patient bracelet – Babygirl Smith, for example. Once the kid is entered into hospital records with that ID, it’s often there until the baby is discharged, even if he or she gets a real name in the meantime.

A study in Pediatrics conducted by researchers aware that such anonymity can invite problems tested a new naming method to see if it reduced potential errors.

As reported on NPR, it’s believed that generic baby names increase the risk of the wrong treatment being given to the wrong patient, especially if the baby is in the neonatal intensive care unit, where about 12 in 100 newborns land.

The neonatal ICU, or NICU, is filled with tiny, often fragile beings requiring complicated care. According to the study’s lead author, Dr. Jason Adelman, an internist and patient safety officer at Montefiore Health System in New York, “All neonatologists know [generic naming] is a problem, but weren’t able to quantify it.”

His team changed naming convention by using a real first name – the mother’s. Instead of Babygirl Smith, that baby would get the ID Donnasgirl Smith. Twins would be 1Donnasgirl Smith and 2Donnasgirl Smith instead of the standard BabygirlA and BabygirlB.

Researchers compared the rate of so-called retract-and-reorder (RAR) events in the years before and after implementing the new ID system. “Retract-and-reorder,” NPR explained, “is a tool that uses the hospital’s computer system to flag medical orders retracted by a health-care worker and then placed by the same worker on a different patient within a short time period.”

The study showed that RAR events declined by more than one-third in the year after the intervention compared with the earlier period.

That doesn’t prove that the new ID system is superior to the old one, but it’s food for hospital thought to consider revising clinical practice.

Keep in mind that the RAR tool does not track medical errors, just close calls. As Dr. Gautham Suresh, a neonatologist not involved in the study explained to NPR, “Say I’m driving down the highway and I almost take the wrong exit but then swing back into the right lane and take the correct exit later. RAR is catching those times when I almost took the wrong exit.”

The researchers also noted that RAR slightly over-reports wrong-patient errors because it includes some false positives. That’s when a test indicates something amiss that leads to more tests and the possibility of complications (such as infection) when, if nothing had been done in the first place, no harm would have occurred.

Although his study analyzed only computerized orders, Adelman said the new naming system has the potential to lower the rate of other kinds of errors, some as simple as taking the wrong container of pumped breast milk from the refrigerator.

Suresh said the study advanced the body of knowledge, but he didn’t go as far as to advise that the new ID system be widely implemented. But he did advocate for further attention to the traditional way babies are named in the hospital, and noted that other factors contribute to wrong-patient mistakes, such as human distraction or poor lighting. “Patient identification errors are complex, and the name is only part of the puzzle,” he says.

The simplest way to avoid them, of course, is to figure out what to call your kid before he or she arrives. Come on, mom and dad … it’s not as if Baby has a vote.

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