Effect of Facilitating Identification of Roles on Team Performance During Emergency Neonatal Resuscitation (Nr)

Abstract

BACKGROUND: Team performance is a major determinant of quality and outcome of NR. A guideline on optimal team composition, positioning, information gathering and appropriate identification of member roles during emergency NR does not exist. OBJECTIVE: Determine the impact of 5 simple instructions on identifying roles and information gathering on team performance during emergency NR. DESIGN/METHODS: Prospective cohort qualitative study was done in a tertiary NICU over two years. Unplanned monthly mock code using a man- nequin and a rhythm generator was initiated in Oct 2008 by trained instruc- tors in NICU. 4 scenarios were used. Interprofessional caregivers were expected to respond to all mock codes as if they were real codes. Following every mock code, instructors prepared a report on team performance using a validated tool. Project was done in 3 phases: (i) Baseline 5 mocks (ii) 6-15 mocks (5 simple instructions were provided and reinforced during debriefing), (iii) Post intervention 16-20. The 5 instructions included; (1) 3A’s before ABC (arrive, ask & articulate roles), (2) identify leader (attend- ing, fellow, nurse practitioner & others in that order to identify themselves), (3) hands-off leader, (4) optimal team configuration & positioning and, (5) charge nurse to reinforce crowd control. Pre and post intervention team performance were analyzed qualitatively. RESULTS: A median of 10 (8-20) caregivers participated in every mock code. Overcrowding (>10 members), failure to gather patient information, lack of a leader and unclear member roles were the major themes identified in every mock code in phase 1. In phase 3, above issues were reported less frequently. Instructors observed that participants found it easier to take on leadership and member roles consistently. Charge nurses addressed over- crowding effectively. Team behavioral markers improved from poor observ- ability in phase 1 to standard observability in phase 3. CONCLUSIONS: Five simple instructions on identifying roles improves team performance