An intervention to improve the work system of neonatal resuscitation teams

Abstract

BackgroundNeonatal resuscitation teams face unique challenges in the delivery of patient care. Our purpose was (a) to understand team challenges and then (b) to improve the work system. MethodsThe user-centred design process involved multiple iterations of requirements gathering, prototype design, evaluation, and redesign. Methods included (1) field observations, (2) interviews with neonatologists (n = 3) and neonatal nurses (n = 4), (3) tabletop evaluations with neonatal clinicians (N = 7), and (4) in-situ simulations (N = 12). ResultsThe intervention comprised the following four prototypes: (1) a four-page resuscitation recording form; (2) a procedural shelf attachment for the resuscitation trolley that provides additional space for sterile procedures; (3) an equipment turntable that allocates equipment layout into four sections that correspond with the steps of resuscitation; and (4) an A3-size display of the neonatal resuscitation algorithm. Simulation-based testing showed a moderate-to-high usability rating of 79.2 on the SUS (system usability scale). ConclusionsA multi-method approach provided (a) novel insight into ‘work as done’ challenges and (b) an intervention designed to address challenges within the work system. This project is an example of a systematic approach to quality improvement in a complex clinical work environment. Subsequent phases will evaluate the prototypes on teamwork and clinical performance measures.