Teamwork and Adherence to Guideline on Newborn Resuscitation—Video Review of Neonatal Interdisciplinary Teams

Frontiers in Pediatrics

article

Lise Brogaard¹  Lone Hvidman¹  Gitte Esberg³  Neil Finer⁴  Kristiane R. Hjorth-Hansen⁵  Tanja Manser⁶  Ole Kierkegaard⁷  Niels Uldbjerg²  Tine B. Henriksen² 

[1] Department of Obstetrics and Gynecology, Aarhus University Hospital;Department of Clinical Medicine, Aarhus University;Department of Pediatrics, Aarhus University Hospital;Department of Neonatology, University of California;Department of Obstetrics and Gynecology, Aalborg University Hospital;School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland;Department of Obstetrics and Gynecology, Horsens Regional Hospital

关键词: neonatal resuscitation;    patient safety;    quality improvement;    video;    teamwork;   

DOI  :  10.3389/fped.2022.828297

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background Little is known about the importance of non-technical skills for the adherence to guidelines, when teams of midwives, obstetricians, anesthesiologists, and pediatricians resuscitate and support the transition of newborns. Non-technical skills are competences underpinning successful teamwork in healthcare. These are usually referred to as leadership, situational awareness, communication, teamwork, decision making, and coping with stress and fatigue. Objective By review of videos of teams managing newborns with difficult transition, we aimed to investigate whether the level of the teams' non-technical skills was associated with the degree of adherence to guidelines for newborn resuscitation and transitional support at birth. Methods Four expert raters independently assessed 43 real-life videos of teams managing newborns with transitional difficulties, two assessed the non-technical score and two assessed the clinical performance. Exposure was the non-technical score, obtained by the Global Assessment Of Team Performance checklist (GAOTP). GAOTP was rated on a Likert Scale 1–5 ( 1 = poor, 3 = average and 5 = excellent). The outcome was the clinical performance score of the team assessed according to adherence of the European Resuscitation Counsel (ERC) guideline for neonatal resuscitation and transitional support. The ERC guideline was adapted into the checklist TeamOBS-Newborn to facilitate a structured and simple performance assessment (low score 0–60, average 60–84, high 85–100). Interrater agreement was analyzed by intraclass correlation (ICC), Bland-Altman analysis, and Cohen's kappa weighted. The risk of high and low clinical performance was analyzed on the logit scale to meet the assumptions of normality and constant standard deviation. Results Teams with an excellent non-technical score had a relative risk 5.5 [95% confidence interval (CI) 2.4–22.5] of high clinical performance score compared to teams with average non-technical score. In addition, we found a dose response like association. The specific non-technical skills associated with the highest degree of adherence to guidelines were leadership and teamwork, coping with stress and fatigue, and communication with parents. Inter-rater agreement was high; raters assessing non-technical skills had an interclass coefficient (ICC) 0.88 (95% CI 0.79–0.94); the neonatologists assessing clinical performance had an ICC of 0.81 (95% CI 0.66–0.89). Conclusion Teams with an excellent non-technical score had five times the chance of high clinical performance compared to teams with average non-technical skills. High performance teams were characterized by good leadership and teamwork, coping with stress, and fatigue and communication with parents.

【 授权许可】

CC BY