Improving Teamwork for Neonatal Resuscitation

Overview

The Neonatal Resuscitation Program (NRP) is the curriculum used to teach providers how to care for newborns in the delivery room. Breakdowns in teamwork and communication contribute to NRP quality problems. Adding teamwork instruction to NRP may be a method to improve communication, teamwork, and the overall quality of neonatal resuscitation. This study uses simulation to incorporate team training into NRP and to evaluate both the effectiveness and duration of the team training. Furthermore, because high fidelity simulation is very expensive and not widely available, we will compare NRP with low fidelity team training to NRP with high fidelity team training. Our hypotheses are: 1. NRP with low fidelity team training results in a) better teamwork, and b) better quality of care compared with standard NRP. 2. NRP with high fidelity team training does not result in better teamwork or better quality of care than NRP with low fidelity simulation. 3. NRP with high fidelity team training does not produce a longer lasting effect on teamwork than NRP with low fidelity simulation.

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Health Services Research
    • Masking: Single (Outcomes Assessor)
  • Study Primary Completion Date: May 2012

Interventions

  • Behavioral: Teamwork training
    • Crew Resource Management (CRM) is an aviation training program mandated for all crew members that teaches human factors concepts, communication skills, and teamwork behaviors that can prevent and manage error. Over the last six years the study team has translated these behaviors to neonatal resuscitation and demonstrated that they can be reliably measured. Adding teamwork instruction to the existing NRP, based upon CRM, may be a method to improve communication, teamwork, and the overall quality of neonatal resuscitation.
  • Behavioral: Standard NRP curriculum
    • The existing NRP course, taught to most caregivers in the United States who care for newborns, focuses on teaching the technical aspects of neonatal resuscitation with little attention paid to communication and teamwork.
  • Behavioral: Skills practice with low-fidelity mannequin
  • Behavioral: Skills practice with high-fidelity mannequin
    • SimBaby mannequins (Laerdal Medical Corp, Stavanger, Norway) were used in the high-fidelity skills stations. These mannequins have simulated heart tones, breath sounds, pulses, and cries.

Arms, Groups and Cohorts

  • Active Comparator: Control (NRP Curriculum with LFT and no team training)
    • Standard Neonatal Resuscitation Program (NRP) curriculum with no team training; simulated resuscitation using low-fidelity simulators for low-fidelity training (LFT)
  • Experimental: NRP with LFT and team training
    • Standard Neonatal Resuscitation Program (NRP) curriculum + team training; simulated resuscitation using low-fidelity simulators for low-fidelity training (LFT)
  • Experimental: NRP with HFT and team training
    • Standard Neonatal Resuscitation Program (NRP) curriculum + team training; simulated resuscitations using high-fidelity simulators for high-fidelity training (HFT)

Clinical Trial Outcome Measures

Primary Measures

  • Teamwork Event Rate
    • Time Frame: During the megacode, which was performed about 1 hour after the training
    • The teamwork event rate was calculated by summing the number of scored teamwork events (sharing information, inquiry, assertion, teaching/advising, and evaluation of plans) and dividing by the total resuscitation time (in minutes).

Secondary Measures

  • Percentage of Time Spent on Workload Management
    • Time Frame: During the megacode, which was performed about 1 hour after the training
    • Workload management percentage was calculated by summing the total time the team demonstrated workload management behavior and dividing by the total resuscitation time.
  • Percentage of Time Spent on Vigilance
    • Time Frame: During the megacode, which was performed about 1 hour after the training
    • Vigilance percentage was calculated by summing the total time the team demonstrated vigilance behavior and dividing by the total resuscitation time.
  • Neonatal Resuscitation Program (NRP) Quality as Assessed by NRP Performance Score
    • Time Frame: During the megacode, which was performed about 1 hour after the training
    • We analyzed 2 measures of NRP quality: performance score and resuscitation duration. The performance score was calculated by averaging the scores (ranging from 0 to 2 – higher values represent a better outcome) for each NRP step (some of which occurred multiple times). Those scores were summed and divided by the total possible score (2 times the number of steps that should have been performed). When a step was not indicated for the specific resuscitation scenario (e.g., meconium aspiration), that step was not scored by the observers and it was not included in the denominator for performance calculation. This produced a measure of performance percentage ranging from 0 percent to 100 percent (higher values represent a better outcome) for each resuscitation.
  • Neonatal Resuscitation Program (NRP) Quality as Assessed by Resuscitation Duration
    • Time Frame: During the megacode, which was performed about 1 hour after the training
    • Resuscitation duration is time required to complete the resuscitation. The total duration for each resuscitation was calculated from the start of the instructor’s reading of the scenario to the team’s statement that the infant should be transferred to the NICU. When any teaching moments occurred during the simulation, the total teaching time was subtracted from the resuscitation duration.

Participating in This Clinical Trial

Inclusion Criteria

  • New interns that enter pediatrics, family medicine, obstetrics/gynecology, and emergency medicine. Exclusion Criteria:

-

Gender Eligibility: All

Minimum Age: N/A

Maximum Age: N/A

Are Healthy Volunteers Accepted: Accepts Healthy Volunteers

Investigator Details

  • Lead Sponsor
    • The University of Texas Health Science Center, Houston
  • Provider of Information About this Clinical Study
    • Principal Investigator: Eric Thomas, Professor – Internal Medicine – The University of Texas Health Science Center, Houston
  • Overall Official(s)
    • Eric J Thomas, MD, MPH, Principal Investigator, The University of Texas Health Science Center, Houston

References

Thomas EJ, Sexton JB, Helmreich RL. Translating teamwork behaviours from aviation to healthcare: development of behavioural markers for neonatal resuscitation. Qual Saf Health Care. 2004 Oct;13 Suppl 1:i57-64.

Thomas EJ, Sexton JB, Lasky RE, Helmreich RL, Crandell DS, Tyson J. Teamwork and quality during neonatal care in the delivery room. J Perinatol. 2006 Mar;26(3):163-9.

Thomas EJ, Taggart B, Crandell S, Lasky RE, Williams AL, Love LJ, Sexton JB, Tyson JE, Helmreich RL. Teaching teamwork during the Neonatal Resuscitation Program: a randomized trial. J Perinatol. 2007 Jul;27(7):409-14. Epub 2007 Jun 7.

Citations Reporting on Results

Thomas EJ, Williams AL, Reichman EF, Lasky RE, Crandell S, Taggart WR. Team training in the neonatal resuscitation program for interns: teamwork and quality of resuscitations. Pediatrics. 2010 Mar;125(3):539-46. doi: 10.1542/peds.2009-1635. Epub 2010 Feb 15.

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