Assessment of temporal variations in adherence to NRP using video recording in the delivery room

A survey of team culture and learning organization in the resuscitation of neonates with congenital anomalies: A single center experience

Aim

Delivery room resuscitation of neonates with congenital anomalies is complex. This study aimed to assess survey psychometrics and measure learning organization culture among resuscitation team members in a pediatric hospital delivery room dedicated to neonates with congenital anomalies.

Methods

We administered the Short-Form Learning Organization Survey with the addition of an open-ended question to all delivery room resuscitation team members from 5/2023 to 7/2023. Psychometric properties were assessed to confirm the survey's reliability and validity in the delivery room context. Total and subscale scores were calculated, and differences were assessed by clinical role. The open-ended qualitative data were analyzed using an inductive approach and coded for theme and valence (positive, negative, neutral).

Results

The response rate was 52% (159/307) with all roles represented. Psychometric assessment produced a 25-item survey with high reliability and validity. There were no differences in total scores across roles. Nurses had higher scores compared to attending physicians (p < 0.01) and advanced practice providers (p < 0.05) for the supportive learning environment subscale, and advanced practice providers (p < 0.05) for the training subscale after multiple comparisons adjustment. Qualitative analysis revealed seven themes: time constraint, environment, adequate staffing, different opinions, care deviations, leadership, and training. Valence analysis showed variation by role, with more positive nursing responses.

Conclusion

The refined 25-item Short-Form Learning Organization Survey is a reliable and valid measure of learning organization culture for neonatal resuscitation teams. Differences in subscale scores and qualitative valence across roles highlight opportunities to improve interprofessional learning organization and team culture.

Neonatal resuscitation program (NRP) guidelines and timing of major resuscitation events in delivery rooms at a level III NICU: Understanding deviations

Objective

To describe the timing of major resuscitation events in the Delivery room.

Methods

A retrospective study of neonates born at a level III birthing hospital who received chest compressions in the delivery room was conducted. The timing of the resuscitation events i.e., intubation, UVC, endotracheal (ETT), epinephrine and intravenous (IV) epinephrine were described. The timing of these events were compared for deliveries with the presence of neonatology team.

Results

51 neonates were included. The primary outcome occurred in 28 (65%) of deliveries. An alternate airway was secured at 4.24 ± 5.9 minutes. Endotracheal epinephrine and IV epinephrine were administered at a mean time of 3.98 ± 3 minutes and 10.87± 5.18 minutes after the initiation of chest compressions respectively.

Conclusion

Data from real-life cases on the timeline of events suggest that major resuscitation events as suggested by Neonatal Resuscitation Program Guidelines, are often significantly delayed.