Characterization of teamwork and guideline compliance in prehospital neonatal resuscitation simulations
Aim: Neonatal cardiopulmonary arrests are rare but serious events. There is limited information on compliance to best-practice guidelines due to rarity, but deviations can have dire consequences. This research aimed to characterize compliance with and deviations from Neonatal Resuscitation Program (...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-06-01
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| Series: | Resuscitation Plus |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666520422000480 |
| _version_ | 1818156814287503360 |
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| author | Nathan Bahr Trang Kieu Huynh William Lambert Jeanne-Marie Guise |
| author_facet | Nathan Bahr Trang Kieu Huynh William Lambert Jeanne-Marie Guise |
| author_sort | Nathan Bahr |
| collection | DOAJ |
| description | Aim: Neonatal cardiopulmonary arrests are rare but serious events. There is limited information on compliance to best-practice guidelines due to rarity, but deviations can have dire consequences. This research aimed to characterize compliance with and deviations from Neonatal Resuscitation Program (NRP) guidelines and their association with teamwork. Methods: We observed Emergency Medical Service (EMS) teams responding to standardized neonatal resuscitation simulations following a precipitous home delivery. A Clinical expert evaluated teamwork during simulations using the Clinical Teamwork Scale (CTS™). A neonatologist evaluated technical performance in blinded video review according to NRP guidelines. We report the types, counts, and severity of observed deviations. Logistic regression tested the association of CTS™ factors with the occurrence of deviations. Results: Forty-five (45) teams of 265 EMS personnel from fire and transport agencies participated in the simulations. Eighty-seven percent (39/45) of teams were rated as having good teamwork according to CTS™. Nearly all teams (44 of 45) delayed or did not perform one or more of the initial steps of dry, warm, or stimulate; delayed bag-valve mask ventilation (BVM); or performed continuous compressions instead of the recommended 3:1 compression-to-ventilation ratio. Logistic regression revealed an 82% (p < 0.04) decrease in the odds of airway errors for each level of improvement in teams’ decision-making. Conclusion: Drying, warming, and stimulating, and ventilation tailored to the physiologic needs of infants continue to be top priorities in neonatal care for out-of-hospital settings. EMS teamwork is good and higher quality of decision-making appears to decrease the odds of ventilation errors. |
| first_indexed | 2024-12-11T15:04:16Z |
| format | Article |
| id | doaj.art-8268815572b6479d994713d9e8475162 |
| institution | Directory Open Access Journal |
| issn | 2666-5204 |
| language | English |
| last_indexed | 2024-12-11T15:04:16Z |
| publishDate | 2022-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Resuscitation Plus |
| spelling | doaj.art-8268815572b6479d994713d9e84751622022-12-22T01:01:00ZengElsevierResuscitation Plus2666-52042022-06-0110100248Characterization of teamwork and guideline compliance in prehospital neonatal resuscitation simulationsNathan Bahr0Trang Kieu Huynh1William Lambert2Jeanne-Marie Guise3Department of Obstetrics and Gynecology, Oregon Health and Science University; Corresponding author at: Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, BH 3029, Portland, OR 97239, United States.Department of Pediatrics, Oregon Health and Science University, United StatesPublic Health and Preventative Medicine, Oregon Health and Science UniversityDepartment of Obstetrics and Gynecology, Oregon Health and Science UniversityAim: Neonatal cardiopulmonary arrests are rare but serious events. There is limited information on compliance to best-practice guidelines due to rarity, but deviations can have dire consequences. This research aimed to characterize compliance with and deviations from Neonatal Resuscitation Program (NRP) guidelines and their association with teamwork. Methods: We observed Emergency Medical Service (EMS) teams responding to standardized neonatal resuscitation simulations following a precipitous home delivery. A Clinical expert evaluated teamwork during simulations using the Clinical Teamwork Scale (CTS™). A neonatologist evaluated technical performance in blinded video review according to NRP guidelines. We report the types, counts, and severity of observed deviations. Logistic regression tested the association of CTS™ factors with the occurrence of deviations. Results: Forty-five (45) teams of 265 EMS personnel from fire and transport agencies participated in the simulations. Eighty-seven percent (39/45) of teams were rated as having good teamwork according to CTS™. Nearly all teams (44 of 45) delayed or did not perform one or more of the initial steps of dry, warm, or stimulate; delayed bag-valve mask ventilation (BVM); or performed continuous compressions instead of the recommended 3:1 compression-to-ventilation ratio. Logistic regression revealed an 82% (p < 0.04) decrease in the odds of airway errors for each level of improvement in teams’ decision-making. Conclusion: Drying, warming, and stimulating, and ventilation tailored to the physiologic needs of infants continue to be top priorities in neonatal care for out-of-hospital settings. EMS teamwork is good and higher quality of decision-making appears to decrease the odds of ventilation errors.http://www.sciencedirect.com/science/article/pii/S2666520422000480Neonatal Resuscitation ProgramCardiac arrestEmergency medical servicesAdverse Safety EventsClinical Teamwork Scale |
| spellingShingle | Nathan Bahr Trang Kieu Huynh William Lambert Jeanne-Marie Guise Characterization of teamwork and guideline compliance in prehospital neonatal resuscitation simulations Resuscitation Plus Neonatal Resuscitation Program Cardiac arrest Emergency medical services Adverse Safety Events Clinical Teamwork Scale |
| title | Characterization of teamwork and guideline compliance in prehospital neonatal resuscitation simulations |
| title_full | Characterization of teamwork and guideline compliance in prehospital neonatal resuscitation simulations |
| title_fullStr | Characterization of teamwork and guideline compliance in prehospital neonatal resuscitation simulations |
| title_full_unstemmed | Characterization of teamwork and guideline compliance in prehospital neonatal resuscitation simulations |
| title_short | Characterization of teamwork and guideline compliance in prehospital neonatal resuscitation simulations |
| title_sort | characterization of teamwork and guideline compliance in prehospital neonatal resuscitation simulations |
| topic | Neonatal Resuscitation Program Cardiac arrest Emergency medical services Adverse Safety Events Clinical Teamwork Scale |
| url | http://www.sciencedirect.com/science/article/pii/S2666520422000480 |
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