Acute Care/Hospitalization

Interns taught teamwork during neonatal resuscitation training may be better able to resuscitate newborns

When babies are born, and their source of oxygen switches from the umbilical cord to their lungs, they sometimes need help establishing their breathing. The Neonatal Resuscitation Program (NRP) trains caregivers how to resuscitate newborns in the delivery room to establish their airway, breathing, and circulation. The NRP could improve the outcomes of thousands of newborns each year. Yet 30 percent of NRP steps are not performed or are performed incorrectly, and pediatric residents often fail to correctly insert breathing tubes in infants. Breakdowns in teamwork appear to contribute to these problems.

When interns received a 2.5 hour segment on teamwork and human error as part of the 1-day NRP course, they demonstrated more team behaviors during simulated neonatal resuscitations than interns in the regular NRP course. Eric Thomas, M.D., M.P.H., of the University of Texas, and colleagues randomized 40 interns to receive NRP with team training or standard NRP, and then video recorded their performance of simulated resuscitations.

The team training group demonstrated three times as many team behaviors than the control group (3.34 vs. 1.03 team behaviors per minute). Team interns were more likely to ask each other about information related to the resuscitation (0.35 vs. 0.09 episodes per minute), share information about the infant's heart rate, color, tone, etc. during noncritical moments (1.06 vs. 0.13), and assert opinions about the resuscitation process during critical times (1.80 vs. 0.64).

All team-trained interns were totally focused on the simulated resuscitation, and 88 percent prioritized and distributed team tasks (workload management) compared with 53 percent and 20 percent, respectively, of interns in the control group. There was no group difference in the frequency of evaluation of plans (detailed discussion of the status of the baby and plans to improve it).

The study was supported by the Agency for Healthcare Research and Quality (HS11544).

See "Teaching teamwork during the neonatal resuscitation program: A randomized trial," by Dr. Thomas, B. Taggart, S. Crandell, and others in the July 2007 Journal of Perinatology 27, pp. 409-414.

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