Board #168 - Research Abstract Impact of Standardized Communication Techniques on Errors During Simulated Neonatal Resuscitation (Submission #8021)

Abstract

Hypothesis Healthcare professionals (HCPs) have a 16-55% error rate in adherence to the Neonatal Resuscitation Program (NRP) algorithm. Poor communication has been highly correlated with noncompliance with NRP steps.1-2 Research in information-dense and high-risk fields such as aviation and air traffic control has shown that 70% of airline accidents are due to human error and 80% of errors are due to communication.3 In these disciplines, team training and effective communication are critical to decrease errors and optimize outcomes, particularly in scenarios that require synthesis of multiple data streams to mitigate potentially fatal problems. Use of stereotyped communication behaviors has been proven to decrease error rates in these fields. We hypothesize that 1) During simulated neonatal resuscitation, HCPs will commit reproducible patterns of errors when implementing the NRP algorithm and 2) Focused training in effective communication strategies will decrease the error rate. Methods In a randomized cross-over study, subjects performed as lead resuscitator in two simulated neonatal resuscitations. Two confederates were trained to use or not use a standardized resuscitation lexicon based on randomization. Subjects led one scenario in which confederates used non-standard communication and a second in which confederates used the resuscitation lexicon. Order of scenarios and communication methods were randomized. The resuscitation lexicon was patterned after communication techniques that have decreased error rates in aviation and air traffic control: standard phraseology, data prioritization, directed task distribution and closed-loop communication. An NRP instructor blinded to group assignment reviewed each videotaped resuscitation for number and types of errors committed. Primary outcome measures were calculated percent error rate, time to initiation of positive pressure ventilation, and time to initiation of chest compressions. Results A total of 13 subjects were recruited for participation in this study: five attending neonatologists, three neonatal hospitalists, three neonatal nurse practitioners, and two neonatology fellows. Seven subjects were exposed to the non-standardized communication in the first scenario. The other six subjects were exposed to the standardized resuscitation lexicon in the first scenario. Order of clinical scenarios was also evenly and randomly assigned. Statistical analysis of the data is currently underway. Average number of communication techniques used in the resuscitation lexicon group was 15.5, compared to 6.7 in the non-standard communication group. The average error rate in the non-standard communication group was 40.4%, compared to 37.2% in the resuscitation lexicon group. Average time to initiation of positive pressure ventilation (PPV) and chest compressions (CC) was decreased in the resuscitation lexicon group (30.7 sec vs. 32.4 sec, and 112.8 sec vs. 120.7 sec). Conclusion Raw data indicate the confederates performed appropriately to expose subjects to the resuscitation lexicon. There did not appear to be a significant decrease in error rate between the control group and the intervention group. Further analysis is underway to identify any underlying patterns to explain this finding. There was an approximately two-second improvement in time to initiation of PPV and eight-second improvement in time to initiation of CC. While statistical analysis is still pending, these differences could be clinically significant. This study has generated novel, objective data about the rate and types of errors made during neonatal resuscitation and the efficacy of standardized communication to decrease those errors. Focused training in communication has the potential to standardize communication throughout healthcare in much the same way it has been systematized in aviation and air traffic control.