Video performance-debriefings and ventilation-refreshers improve quality of neonatal resuscitation

RESUSCITATION

卷:132

Article

Skare, Christiane^1,2,3  Boldingh, Anne Marthe^4,5,6  Kramer-Johansen, Jo^1,2,3  Consch, Tor Einar⁷  Nakstad, Britt^4,5,6  Nadkarni, Vinay⁸  Olasveengen, Theresa M.²  Niles, Dana E.⁹ 

[1] Oslo Univ Hosp, Norwegian Natl Advisory Unit Prehosp Emergency Ca, Oslo, Norway

[2] Oslo Univ Hosp, Dept Anaesthesiol, PB 4956 Nydalen, N-0424 Oslo, Norway

[3] Univ Oslo, Oslo, Norway

[4] Univ Oslo, Dept Paediat & Adolescent Med, Lorenskog, Norway

[5] Univ Oslo, Inst Clin Med, Lorenskog, Norway

[6] Akershus Univ Hosp, Lorenskog, Norway

[7] Oslo Univ Hosp, Neonatal Intens Care Unit, Oslo, Norway

[8] Univ Penn, Childrens Hosp Philadelphia, Dept Anesthesia Crit Care & Pediat, Perelman Sch Med, Philadelphia, PA 19104 USA

[9] Childrens Hosp Philadelphia, Ctr Simulat Adv Educ & Innovat, Philadelphia, PA 19104 USA

关键词: Neonatal resuscitation;    Education;    Debriefing;    Performance-based debriefing;    In-situ high-frequency simulation training;    Refresher training;    Positive pressure ventilation;    Adherence to guidelines;    Implementation;    Video assessment;    Clinical outcome;   

DOI  :  10.1016/j.resuscitation.2018.07.013

来源: Elsevier

【 摘 要 】

Aim: Providers caring for newly born infants require skills and knowledge to initiate prompt and effective positive pressure ventilation (PPV) if the newborn does not breathe spontaneously after birth. We hypothesized implementation of high frequency/short duration deliberate practice training and post event video-based debriefings would improve process of care and decreases time to effective spontaneous respiration. Methods: Pre- and post-interventional quality study performed at two Norwegian university hospitals. All newborns receiving PPV were prospectively video-recorded, and initial performance data guided the development of educational interventions. A priori primary outcome was changed from process of care using the Neonatal Resuscitation Performance Evaluation (NRPE) score to time to effective spontaneous respiration as the NRPE score could only be obtained from one site due to lack of staff resources. Results: Over 12 months, 297 PPV-Refreshers and 52 performance debriefings were completed with 227 unique providers attending a PPV-Refresher and 93 unique providers completed a debriefing. We compared 102 PPV-events pre- to 160 PPV-events post-bundle implementation. The time to effective spontaneous respiration decreased from median (95% confidence interval) 196 (140-237) to 144 (120-163) s, p = 0.010. The NRPE-score increased significantly from median 77% (75-81) pre- to 89% (86-92) post-implementation, p < 0.001. There were no significant differences in time to heart rate > 100 beats/min or number of newborns transferred to intensive care. Conclusion: High frequency/short duration deliberate practice PPV psychomotor training combined with performance-focused team debriefings using video recordings of actual resuscitations may improve time to effective spontaneous breathing and adherence to guidelines during real neonatal resuscitations.

【 授权许可】

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