364 - Improving Communication in Neonatal Emergencies by Establishing a Neonatal Resuscitation Team (NRT) in a Community Hospital Affiliated with an Academic Medical Center
Assistant Professor of Pediatrics Weill Cornell Medicine West New York, New Jersey, United States
Background: According to the NRP, most newborns make the transition to extrauterine life without intervention. However, 2% of term newborns require intubation and 1-3 babies per 1,000 births will need extensive neonatal resuscitation (NRT). Because the need for assistance cannot always be predicted, obstetric and neonatal teams need to have effective communication to provide these lifesaving interventions quickly and efficiently in the delivery room (DR). Objective: To increase the rate of Neonatology attendance at high-risk deliveries to >75% by September 2023. Design/Methods: This is an observational quality improvement (QI) study using sequential, planned experimentation in a community hospital affiliated with an academic medical center from May 2022 to August 2023. An interdisciplinary QI team including neonatology, obstetrics, IT, anesthesiology, and PA staff met to design the Key Driver Diagram (Figure 1) and Process Map (Figure 2). We used the Model for Improvement to define the study measures including the number of appropriate emergency alerts and notifications to the NRT (process), rate of Neonatology attendance at high-risk deliveries (process), number of serious safety events in the delivery room (outcome) and no change in adverse events in the NICU while the NRT team is in the DR (balancing).Statistical process control charts (P-charts) were used to display and analyze data. API rules were applied to detect special cause variation. Results: A total of 2,438 maternal charts were reviewed for any indications for DR attendance by the NRT. We improved NRT notification via EMR chat from 13% to 70% (Figure 3A). We also improved the rate of Neonatology attendance at high-risk deliveries from 59% to 91% (Figure 3B). There were no NICU adverse events while NRT team was in the delivery room.
Conclusion(s): In this study we leveraged EHR tools and process mapping to streamline communication between teams whose presence is critical to neonatal resuscitation. The most effective interventions included situational awareness group chat, NRT alert code and adaptation of delivery room guidelines. Next steps include scaling up to other community hospitals in the network. LMH NRT-2.jpeg
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