Heidi M Herrick1, Scott Lorch2, Jesse Y Hsu3, Kenneth Catchpole4, Elizabeth E Foglia5. 1. Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Division of Neonatology, 2(nd) Floor, Main Building, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA. Electronic address: herrickh@email.chop.edu. 2. Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Division of Neonatology, 2(nd) Floor, Main Building, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA. Electronic address: Lorch@email.chop.edu. 3. Department of Biostatistics, Epidemiology, and Informatics at The University of Pennsylvania Perelman School of Medicine, 629 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA. Electronic address: Jesse.Hsu@pennmedicine.upenn.edu. 4. Department of Anesthesia and Perioperative Medicine & College of Nursing at The Medical University of South Carolina, Storm Eye Building, 167 Ashley Avenue, Suite 301, MSC 912, Charleston, SC 29425-9120, USA. Electronic address: catchpol@musc.edu. 5. Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Division of Neonatology, 2(nd) Floor, Main Building, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA. Electronic address: foglia@email.chop.edu.
Abstract
AIM: Flow disruptions (FDs) are deviations from the progression of care that compromise safety and efficiency of a specific process. The study aim was to identify the impact of FDs during neonatal resuscitation and determine their association with key process and outcome measures. METHODS: Prospective observational study of video recorded delivery room resuscitations of neonates <32 weeks gestational age. FDs were classified using an adaptation of Wiegmann's FD tool. The primary outcome was target oxygenation saturation achievement at 5 min. Secondary outcomes included achieving target saturation at 10 min, time to positive pressure ventilation for initially apnoeic/bradycardic neonates, time to electrocardiogram signal, time to pulse oximetry signal, and time to stable airway. Multivariable logistic regression assessed association between FDs and achieving target saturations adjusting for gestational age and leader. Associations between FDs and time to event outcomes were assessed using Cox proportional hazards models. RESULTS: Between 10/2017-7/2018, 32 videos were included. A mean of 52.6 FDs (standard deviation 17.9) occurred per resuscitation. Extraneous FDs were the most common FDs. FDs were associated with an adjusted odds ratio of 0.92 (95% confidence interval [CI] 0.80-1.05) of achieving target saturation at 5 min and 0.94 (95% CI 0.84-1.05) at 10 min. There was no significant evidence to show FDs were associated with time to event outcomes. CONCLUSIONS: FDs occurred frequently during neonatal resuscitation. Measuring FDs is a feasible method to assess the impact of human factors in the delivery room and identify modifiable factors and practices to improve patient care.
AIM: Flow disruptions (FDs) are deviations from the progression of care that compromise safety and efficiency of a specific process. The study aim was to identify the impact of FDs during neonatal resuscitation and determine their association with key process and outcome measures. METHODS: Prospective observational study of video recorded delivery room resuscitations of neonates <32 weeks gestational age. FDs were classified using an adaptation of Wiegmann's FD tool. The primary outcome was target oxygenation saturation achievement at 5 min. Secondary outcomes included achieving target saturation at 10 min, time to positive pressure ventilation for initially apnoeic/bradycardic neonates, time to electrocardiogram signal, time to pulse oximetry signal, and time to stable airway. Multivariable logistic regression assessed association between FDs and achieving target saturations adjusting for gestational age and leader. Associations between FDs and time to event outcomes were assessed using Cox proportional hazards models. RESULTS: Between 10/2017-7/2018, 32 videos were included. A mean of 52.6 FDs (standard deviation 17.9) occurred per resuscitation. Extraneous FDs were the most common FDs. FDs were associated with an adjusted odds ratio of 0.92 (95% confidence interval [CI] 0.80-1.05) of achieving target saturation at 5 min and 0.94 (95% CI 0.84-1.05) at 10 min. There was no significant evidence to show FDs were associated with time to event outcomes. CONCLUSIONS: FDs occurred frequently during neonatal resuscitation. Measuring FDs is a feasible method to assess the impact of human factors in the delivery room and identify modifiable factors and practices to improve patient care.
Authors: Ken R Catchpole; Anthony E B Giddings; Michael Wilkinson; Guy Hirst; Trevor Dale; Marc R de Leval Journal: Surgery Date: 2007-07 Impact factor: 3.982
Authors: Tara N Cohen; Douglas A Wiegmann; Scott T Reeves; Albert J Boquet; Scott A Shappell Journal: Am J Med Qual Date: 2016-10-25 Impact factor: 1.852
Authors: Ken Catchpole; Eric Ley; Doug Wiegmann; Jennifer Blaha; Daniel Shouhed; Alexandra Gangi; Renaldo Blocker; Richard Karl; Cathy Karl; Bill Taggart; Benjamin Starnes; Bruce Gewertz Journal: JAMA Surg Date: 2014-09 Impact factor: 14.766
Authors: Lindsay Johnston; Taylor Sawyer; Anne Ades; Ahmed Moussa; Jeanne Zenge; Philipp Jung; Stephen DeMeo; Kristen Glass; Neetu Singh; Alexandra Howlett; Justine Shults; James Barry; Brianna Brei; Elizabeth Foglia; Akira Nishisaki Journal: Neonatology Date: 2021-06-10 Impact factor: 5.106