Presentation
HE11 - Process Improvement Through Reviewing Recorded Neonatal Resuscitations
DescriptionBackground:
Newborn resuscitation is a time-pressured activity requiring teams of healthcare professionals to coordinate invasive procedures in a specific sequence of steps in a highly confined physical space. There are over 170 total physician, nursing, nurse practitioner, and respiratory care staff who can attend a newborn delivery at our academic children’s hospital with a high-risk obstetrics service and a Level 4 NICU, leading to over 10 billion different team iterations that could attend a complex delivery at any given time.
Objective:
Analyze recorded neonatal resuscitations and identify areas for improvement. Design and implement process changes to improve team performance.
Methods:
Over 200 hundred recorded neonatal resuscitations have been reviewed by the lead author between 2019 and 2023. In that time, we identified the following key areas of improvement that would support better team performance: (1) need for role clarity and task allocation among delivery team members, (2) communication challenges when calling for Neonatal Delivery Teams, and (3) variation in preparation for complex deliveries.
Results:
To improve role clarity for delivery teams, delivery team huddles are now held twice a day that involve all disciplines (MD/DO, RN, RT). Anticipated deliveries are discussed, and a diagram of the neonatal bedside is filled out for the team that will attend deliveries that shift. The diagram includes descriptions of each role and the tasks for which they are responsible during the resuscitation. To improve communication in calling for Neonatal Delivery Teams, verbiage was altered from “standard” and “complex” deliveries to “Level 1, 2 and 3” deliveries. A chart was created that defines the clinical indications and team composition for each type of Neonatal Delivery Team. Staff from Labor and Delivery (L&D) utilize the chart to accurately call for the correct Neonatal Delivery Team. To better prepare for high acuity deliveries, we developed pre-stocked bags of supplies needed for specific prenatal diagnoses such as hydrops and neural tube defects. These bags can be easily brought to the delivery room to ensure the team has all equipment ready in a timely manner. NRP recommends holding a briefing prior to every delivery, but implementation of briefings prior to deliveries was variable. We now utilize a premade briefing checklist for all Level 2 and 3 (higher acuity) deliveries as well as briefing checklists for specific prenatal diagnoses. This standardized briefing process ensures every team has a shared mental model and is better prepared to respond to changes in circumstances.
Conclusion:
By reviewing recorded neonatal resuscitations, we identified areas for improvement that were specific to our institution. We worked with stakeholders in all disciplines to implement multiple changes that have clarified neonatal resuscitation team roles and responsibilities, streamlined communication between NICU and L&D, and enhanced our resuscitation teams’ preparation for complex deliveries.
Newborn resuscitation is a time-pressured activity requiring teams of healthcare professionals to coordinate invasive procedures in a specific sequence of steps in a highly confined physical space. There are over 170 total physician, nursing, nurse practitioner, and respiratory care staff who can attend a newborn delivery at our academic children’s hospital with a high-risk obstetrics service and a Level 4 NICU, leading to over 10 billion different team iterations that could attend a complex delivery at any given time.
Objective:
Analyze recorded neonatal resuscitations and identify areas for improvement. Design and implement process changes to improve team performance.
Methods:
Over 200 hundred recorded neonatal resuscitations have been reviewed by the lead author between 2019 and 2023. In that time, we identified the following key areas of improvement that would support better team performance: (1) need for role clarity and task allocation among delivery team members, (2) communication challenges when calling for Neonatal Delivery Teams, and (3) variation in preparation for complex deliveries.
Results:
To improve role clarity for delivery teams, delivery team huddles are now held twice a day that involve all disciplines (MD/DO, RN, RT). Anticipated deliveries are discussed, and a diagram of the neonatal bedside is filled out for the team that will attend deliveries that shift. The diagram includes descriptions of each role and the tasks for which they are responsible during the resuscitation. To improve communication in calling for Neonatal Delivery Teams, verbiage was altered from “standard” and “complex” deliveries to “Level 1, 2 and 3” deliveries. A chart was created that defines the clinical indications and team composition for each type of Neonatal Delivery Team. Staff from Labor and Delivery (L&D) utilize the chart to accurately call for the correct Neonatal Delivery Team. To better prepare for high acuity deliveries, we developed pre-stocked bags of supplies needed for specific prenatal diagnoses such as hydrops and neural tube defects. These bags can be easily brought to the delivery room to ensure the team has all equipment ready in a timely manner. NRP recommends holding a briefing prior to every delivery, but implementation of briefings prior to deliveries was variable. We now utilize a premade briefing checklist for all Level 2 and 3 (higher acuity) deliveries as well as briefing checklists for specific prenatal diagnoses. This standardized briefing process ensures every team has a shared mental model and is better prepared to respond to changes in circumstances.
Conclusion:
By reviewing recorded neonatal resuscitations, we identified areas for improvement that were specific to our institution. We worked with stakeholders in all disciplines to implement multiple changes that have clarified neonatal resuscitation team roles and responsibilities, streamlined communication between NICU and L&D, and enhanced our resuscitation teams’ preparation for complex deliveries.
Event Type
Poster Presentation
TimeTuesday, March 264:45pm - 6:15pm CDT
LocationSalon C
Digital Health
Simulation and Education
Hospital Environments
Medical and Drug Delivery Devices
Patient Safety Research and Initiatives