Enhancing Communication and Response for Care of Newborns at Risk of Complications

Abstract

Paper Presentation Purpose for the Program To outline innovative enhancements to the communication system and processes used by health care providers across departments and disciplines to provide a rapid response and effective care for the compromised or potentially compromised newborn. Proposed Change The previous system for responding to events involving a compromised newborn was an unstructured and informal process that included multiple telephone calls, alerting of nondedicated pagers, and often required business associates to relay critical clinical details. Multiple points of communication opened opportunities for handoff failures, loss of information, and delay in response. The multidisciplinary Perinatal Committee designated this issue for a high‐priority quality improvement project, including leadership from obstetrics (OB), pediatrics, and telecommunications. A collaborative process was used to engage multiple units across the Children's Hospital (newborn special care unit, labor and birth, maternal special care unit, maternity/well newborn, pediatric emergency department [ED], and adult ED). The existing Yale‐New Haven Hospital Emergency155‐page system was engaged and modified to accommodate the newborn response calls. New telephones were designated for newborn emergencies in each delivery room and within key departments, newborn response indicators were revised, and a response escalation system was implemented to ensure notification in the event of delayed newborn response. Implementation, Outcomes, and Evaluation A direct paging system that involved scripting at the point of need when calling for a newborn response team was implemented. A numerical code system was developed to designate the primary clinical indication. The clinical indication and location for response is presented on alphanumeric pagers within seconds of the initial response call. Key neonatal providers are now carrying pagers. The NICU has designated dedicated response teams and teams for deliveries. A call escalation system ensures notification of other providers in cases of a delayed response or for emergent situations. Incorporating charge nurses and unit leadership into the notification system has improved situational awareness. Telecommunications and AT&T monitor and document all calls for quality assurance. An evaluation of postimplementation data indicated a 98.3% successful response rate when using the enhanced response system with an average response time of 2.5 minutes. Continuous communication with disciplines involved promotes analysis of current state and reveals areas for improvement. Implications for Nursing Practice Improvements to the system enhance safety and improve the comfort level of nurses to perform rapid responses for newborns. Simple processes, scripting, and shared responsibility for the system promotes teamwork and efficiency, potentially improving neonatal outcomes for the compromised newborn.