Improving Teamwork for Neonatal Resuscitation

Not Applicable

Completed

Conditions: Teamwork During Neonatal Resuscitation

Interventions: Behavioral: Standard NRP curriculum
Behavioral: Teamwork training
Behavioral: Skills practice with low-fidelity mannequin
Behavioral: Skills practice with high-fidelity mannequin

Registration Number: NCT00651794

Lead Sponsor: The University of Texas Health Science Center, Houston

Brief Summary: 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.

Detailed Description: Not available

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 100

Inclusion Criteria

New interns that enter pediatrics, family medicine, obstetrics/gynecology, and emergency medicine.

Exclusion Criteria

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Control (NRP Curriculum with LFT and no team training)	Skills practice with low-fidelity mannequin	Standard Neonatal Resuscitation Program (NRP) curriculum with no team training; simulated resuscitation using low-fidelity simulators for low-fidelity training (LFT)
NRP with LFT and team training	Skills practice with low-fidelity mannequin	Standard Neonatal Resuscitation Program (NRP) curriculum + team training; simulated resuscitation using low-fidelity simulators for low-fidelity training (LFT)
NRP with HFT and team training	Skills practice with high-fidelity mannequin	Standard Neonatal Resuscitation Program (NRP) curriculum + team training; simulated resuscitations using high-fidelity simulators for high-fidelity training (HFT)
Control (NRP Curriculum with LFT and no team training)	Standard NRP curriculum	Standard Neonatal Resuscitation Program (NRP) curriculum with no team training; simulated resuscitation using low-fidelity simulators for low-fidelity training (LFT)
NRP with HFT and team training	Standard NRP curriculum	Standard Neonatal Resuscitation Program (NRP) curriculum + team training; simulated resuscitations using high-fidelity simulators for high-fidelity training (HFT)
NRP with LFT and team training	Teamwork training	Standard Neonatal Resuscitation Program (NRP) curriculum + team training; simulated resuscitation using low-fidelity simulators for low-fidelity training (LFT)
NRP with LFT and team training	Standard NRP curriculum	Standard Neonatal Resuscitation Program (NRP) curriculum + team training; simulated resuscitation using low-fidelity simulators for low-fidelity training (LFT)
NRP with HFT and team training	Teamwork training	Standard Neonatal Resuscitation Program (NRP) curriculum + team training; simulated resuscitations using high-fidelity simulators for high-fidelity training (HFT)

Primary Outcome Measures

Name	Time	Method
Teamwork Event Rate	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 Outcome Measures

Name	Time	Method
Percentage of Time Spent on Workload Management	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	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	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	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.