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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:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control (NRP Curriculum with LFT and no team training) | Active Comparator | Standard Neonatal Resuscitation Program (NRP) curriculum with no team training; simulated resuscitation using low-fidelity simulators for low-fidelity training (LFT) |
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| NRP with LFT and team training | Experimental | Standard Neonatal Resuscitation Program (NRP) curriculum + team training; simulated resuscitation using low-fidelity simulators for low-fidelity training (LFT) |
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| NRP with HFT and team training | Experimental | Standard Neonatal Resuscitation Program (NRP) curriculum + team training; simulated resuscitations using high-fidelity simulators for high-fidelity training (HFT) |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Teamwork training | Behavioral | 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. |
| 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 |
| 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 |
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Inclusion Criteria:
Exclusion Criteria:
-
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| Name | Affiliation | Role |
|---|---|---|
| Eric J Thomas, MD, MPH | The University of Texas Health Science Center, Houston | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Texas Health Science Center, Houston | Houston | Texas | 77030 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 15465957 | Background | Thomas EJ, Sexton JB, Helmreich RL. Translating teamwork behaviours from aviation to healthcare: development of behavioural markers for neonatal resuscitation. Qual Saf Health Care. 2004 Oct;13 Suppl 1(Suppl 1):i57-64. doi: 10.1136/qhc.13.suppl_1.i57. | |
| 16493432 | Background | Thomas EJ, Sexton JB, Lasky RE, Helmreich RL, Crandell DS, Tyson J. Teamwork and quality during neonatal care in the delivery room. J Perinatol. 2006 Mar;26(3):163-9. doi: 10.1038/sj.jp.7211451. |
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100 interns were consented, and 98 completed the initial megacode (that is, the initial simulation with a mannequin that was observed and scored). Baseline characteristics are reported for the 98 who completed the initial megacode.
All incoming interns for pediatrics, combined pediatrics and internal medicine, family medicine, emergency medicine, and obstetrics and gynecology who began training in June 2007 or June 2008 and had not previously completed NRP certification were eligible for participation in the study.
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| ID | Title | Description |
|---|---|---|
| FG000 | Control (NRP Curriculum With LFT and no Team Training) | Standard NRP curriculum with no team training; simulated resuscitation using low-fidelity simulators |
| FG001 | NRP With LFT and Team Training | Standard NRP curriculum + team training; simulated resuscitation using low-fidelity simulators |
| FG002 | NRP With HFT and Team Training | Standard NRP curriculum + team training; simulated resuscitations using high-fidelity simulators |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
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| ID | Title | Description |
|---|---|---|
| BG000 | Control (NRP Curriculum With LFT and no Team Training) | Standard NRP curriculum with no team training; simulated resuscitation using low-fidelity simulators |
| BG001 | NRP With LFT and Team Training |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | 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). | Posted | Mean | Standard Deviation | teamwork events per minute | During the megacode, which was performed about 1 hour after the training |
|
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Control (NRP Curriculum With LFT and no Team Training) | Standard NRP curriculum with no team training; simulated resuscitation using low-fidelity simulators |
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Questions remain about whether similar training will be effective for other types of caregivers. Generalizability might be limited if other sites were not able to re-create the team training content.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Eric Thomas | University of Texas HSC-Houston | 713-500-7958 | Eric.Thomas@uth.tmc.edu |
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|
| Standard NRP curriculum | Behavioral | 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. |
|
| Skills practice with low-fidelity mannequin | Behavioral |
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| Skills practice with high-fidelity mannequin | Behavioral | 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. |
|
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 |
| 17538634 | Background | Thomas EJ, Taggart B, Crandell S, Lasky RE, Williams AL, Love LJ, Sexton JB, Tyson JE, Helmreich RL. Teaching teamwork during the Neonatal Resuscitation Program: a randomized trial. J Perinatol. 2007 Jul;27(7):409-14. doi: 10.1038/sj.jp.7211771. Epub 2007 Jun 7. |
| 20156896 | Result | Thomas EJ, Williams AL, Reichman EF, Lasky RE, Crandell S, Taggart WR. Team training in the neonatal resuscitation program for interns: teamwork and quality of resuscitations. Pediatrics. 2010 Mar;125(3):539-46. doi: 10.1542/peds.2009-1635. Epub 2010 Feb 15. |
Standard NRP curriculum + team training; simulated resuscitation using low-fidelity simulators
| BG002 | NRP With HFT and Team Training | Standard NRP curriculum + team training; simulated resuscitations using high-fidelity simulators |
| BG003 | Total | Total of all reporting groups |
| Participants |
|
| Sex/Gender, Customized | Number | participants |
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| Region of Enrollment | Number | participants |
|
| OG002 | NRP With HFT and Team Training | Standard NRP curriculum + team training; simulated resuscitations using high-fidelity simulators |
|
|
| Secondary | 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. | Posted | Mean | Standard Deviation | percentage of time | During the megacode, which was performed about 1 hour after the training |
|
|
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| Secondary | 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. | Posted | Mean | Standard Deviation | percentage of time | During the megacode, which was performed about 1 hour after the training |
|
|
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| Secondary | 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. | Posted | Mean | Standard Deviation | performance percentage | During the megacode, which was performed about 1 hour after the training |
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|
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| Secondary | 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. | Posted | Mean | Standard Deviation | seconds | During the megacode, which was performed about 1 hour after the training |
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| 0 |
| 36 |
| 0 |
| 36 |
| EG001 | NRP With LFT and Team Training | Standard NRP curriculum + team training; simulated resuscitation using low-fidelity simulators | 0 | 31 | 0 | 31 |
| EG002 | NRP With HFT and Team Training | Standard NRP curriculum + team training; simulated resuscitations using high-fidelity simulators | 0 | 31 | 0 | 31 |
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