804 - Team Training Fosters Collaboration in Delivery Room Resuscitation in a Low Resource Hospital

Publication Number: 804.6718

Emily Ahn, Weill Cornell Medicine, New York, NY, United States; Jackline Cypriane. Patrice, Kilimanjaro Christian medical centre, Moshi, Kilimanjaro, Tanzania; Aisa M. Shayo, Kilimanjaro Christian Medical Center and Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Kilimanjaro, Tanzania; Nyemo Peter, Kilimanjaro Christian Medical University College, Kilimanjaro, Kilimanjaro, Tanzania; Jeffrey M. Perlman, Weill Cornell Medicine, New york, NY, United States

Background: At Kilimanjaro Christian Medical Centre midwives and residents have focused on individual skills like bag mask ventilation (BMV), but have not received training in teamwork, team assemble, and debriefing.

Objective: Implement team training for pediatric residents and midwives and determine its impact on care provided during delivery room (DR) resuscitation.

Design/Methods: Prior to this study all participants demonstrated effective BMV skills. Participants completed a half-day workshop focused on DR teamwork. Education covered team assemble; pre-briefing (identifying perinatal risk factors, anticipate resuscitation needs, assign team roles); preparing resuscitation equipment; communication strategies during a resuscitation (narration, closed-loop, one-liner); and post-delivery debriefing. Simulation scenarios were conducted post-training to solidify teaching components. Effectiveness of team training in high-risk deliveries were observed by a research assistant. Cases were discussed weekly and analyzed with descriptive statistics. This work was supported by Thrasher Research Fund and Laerdal Foundation.

Results: 25 pediatric residents and 12 midwives received training. During simulations, participants required prompting to use communication skills. Post training, 40 high-risk DR resuscitations were observed (Table 1). Infants had a gestational age (GA) 34.4 ± 3.1 weeks, birthweight 2.4 ± 0.9 kg, and DR temperature of 36.4 ± 0.4°C. 8 neonates were < 32 weeks GA; 7 were wrapped in plastic to prevent heat loss. For all resuscitations providers prepared equipment, promptly dried the infant, demonstrated team cohesiveness, and showed the infant to the mother (Table 2). Deep suctioning was uncommon and there was no excessive suctioning. 8 infants had no cry after initial steps of resuscitation, 3 of which responded to stimulation and 5 required BMV. Of BMV cases, 4 were effective evidenced by an increase in heart rate and chest rise and 1 died (Table 3). A resident was present prior to delivery in 26/40 (65%) cases; failures were related to precipitous deliveries (n=5), emergencies on other units (n=2); and unexplained late arrival (n=7). A debrief was completed in 5 cases (13%).

Conclusion(s): The benefits of team training included team cohesiveness demonstrated by adherence to initial resuscitation steps including appropriate use of occlusive wrap, avoidance of excessive suctioning, and maternal bonding. Areas for improvement include increasing team attendance prior to high-risk deliveries and debriefings which offer opportunities for learning. Repeated simulations may be necessary to master new team skills.

Classifications of high-risk deliveries.
Table 1.pdf

Assessment of teamwork during high-risk deliveries.
Table 2.pdf

Infant response to resuscitation intervention in apneic infants.
Table 3.pdf