Improving Teamwork for Neonatal Resuscitation

Study Overview
=================
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: NRP with low fidelity team training results in a) better teamwork, and b) better quality of care compared with standard NRP. NRP with high fidelity team training does not result in better teamwork or better quality of care than NRP with low fidelity simulation. NRP with high fidelity team training does not produce a longer lasting effect on teamwork than NRP with low fidelity simulation.

Official Title
-----------------
Improving Teamwork for Neonatal Resuscitation

Conditions
-----------------
Teamwork During Neonatal Resuscitation

Intervention / Treatment
-----------------
* Behavioral: Teamwork training
* Behavioral: Standard NRP curriculum
* Behavioral: Skills practice with low-fidelity mannequin
* Behavioral: Skills practice with high-fidelity mannequin


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: New interns that enter pediatrics, family medicine, obstetrics/gynecology, and emergency medicine. Exclusion Criteria: -
Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Control (NRP Curriculum with LFT and no team training)<br>Standard Neonatal Resuscitation Program (NRP) curriculum with no team training; simulated resuscitation using low-fidelity simulators for low-fidelity training (LFT) | Behavioral: Standard NRP curriculum<br>* The existing NRP course, taught to most caregivers in the United States who care for newborns, focuses on teaching the technical aspects of neonatal resuscitation with little attention paid to communication and teamwork.<br>Behavioral: Skills practice with low-fidelity mannequin<br> <br> |
| Experimental: NRP with LFT and team training<br>Standard Neonatal Resuscitation Program (NRP) curriculum + team training; simulated resuscitation using low-fidelity simulators for low-fidelity training (LFT) | Behavioral: Teamwork training<br>* Crew Resource Management (CRM) is an aviation training program mandated for all crew members that teaches human factors concepts, communication skills, and teamwork behaviors that can prevent and manage error. Over the last six years the study team has translated these behaviors to neonatal resuscitation and demonstrated that they can be reliably measured. Adding teamwork instruction to the existing NRP, based upon CRM, may be a method to improve communication, teamwork, and the overall quality of neonatal resuscitation.<br>Behavioral: Standard NRP curriculum<br>* The existing NRP course, taught to most caregivers in the United States who care for newborns, focuses on teaching the technical aspects of neonatal resuscitation with little attention paid to communication and teamwork.<br>Behavioral: Skills practice with low-fidelity mannequin<br> <br> |
| Experimental: NRP with HFT and team training<br>Standard Neonatal Resuscitation Program (NRP) curriculum + team training; simulated resuscitations using high-fidelity simulators for high-fidelity training (HFT) | Behavioral: Teamwork training<br>* Crew Resource Management (CRM) is an aviation training program mandated for all crew members that teaches human factors concepts, communication skills, and teamwork behaviors that can prevent and manage error. Over the last six years the study team has translated these behaviors to neonatal resuscitation and demonstrated that they can be reliably measured. Adding teamwork instruction to the existing NRP, based upon CRM, may be a method to improve communication, teamwork, and the overall quality of neonatal resuscitation.<br>Behavioral: Standard NRP curriculum<br>* The existing NRP course, taught to most caregivers in the United States who care for newborns, focuses on teaching the technical aspects of neonatal resuscitation with little attention paid to communication and teamwork.<br>Behavioral: Skills practice with high-fidelity mannequin<br>* SimBaby mannequins (Laerdal Medical Corp, Stavanger, Norway) were used in the high-fidelity skills stations. These mannequins have simulated heart tones, breath sounds, pulses, and cries.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Teamwork Event Rate | 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). | During the megacode, which was performed about 1 hour after the training | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of Time Spent on Workload Management | Workload management percentage was calculated by summing the total time the team demonstrated workload management behavior and dividing by the total resuscitation time. | During the megacode, which was performed about 1 hour after the training | 
| Percentage of Time Spent on Vigilance | Vigilance percentage was calculated by summing the total time the team demonstrated vigilance behavior and dividing by the total resuscitation time. | During the megacode, which was performed about 1 hour after the training | 
| Neonatal Resuscitation Program (NRP) Quality as Assessed by NRP Performance Score | 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. | During the megacode, which was performed about 1 hour after the training | 
| Neonatal Resuscitation Program (NRP) Quality as Assessed by Resuscitation Duration | 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. | During the megacode, which was performed about 1 hour after the training | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Neonatal Resuscitation, Patient Care Team, Medical Errors