687 - Delivery Room Resuscitation of Neonates with Congenital Diaphragmatic Hernia; Lessons Learned through Video Review
Monday, May 1, 2023
9:30 AM – 11:30 AM ET
Poster Number: 687 Publication Number: 687.444
K. Taylor Wild, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Natalie Rintoul, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Holly L. Hedrick, Children’s Hospital of Philadelphia, Philadelphia, PA, United States; Elizabeth Foglia, Perelman School of Medicine at the University of Pennsylvania, Swarthmore, PA, United States; Anne Ades, The Children's Hospital of Philadelphia, Philadelphia, PA, United States; Heidi M. Herrick, Childrens Hospital of Philadelphia, Philadelphia, PA, United States
Fellow Physician Children's Hospital of Philadelphia Philadelphia, Pennsylvania, United States
Background: Effective delivery room (DR) resuscitation of neonates with congenital diaphragmatic hernia (CDH) requires many critical interventions to occur in a short period of time. The timing and order of these interventions are not well described, nor are factors that facilitate or impede task performance. DR video recording enables accurate, in-depth resuscitation review, which may provide valuable insights into improving DR care for this high-risk population. Objective: To describe timing and order of CDH DR interventions and identify system factors that impact CDH DR resuscitations. Design/Methods: Single center observational study of video recording DR resuscitations of neonates prenatally diagnosed with CDH. DR video recording is routine practice for quality assurance. Per unit guidelines, neonates with CDH are brought to an adjacent resuscitation room after delivery and immediately intubated. Each video was analyzed by one reviewer for event timing and identification of system factors using the System Engineering Initiative for Patient Safety (SEIPS) model as a framework. Factors were discussed among additional reviewers to reach consensus and identify themes. Results: We analyzed 20 CDH resuscitations from 11/2021-12/2022 (Table 1). Event timing was highly variable within the first 20 minutes of life (Figure 1). A closer look at 5 patients also revealed a wide range in the order of interventions (Figure 2). We identified ‘Internal Environment’ and ‘Tasks’ components of the SEIPS model as prominent resuscitation factors. Specifically, significant room and bed spatial constraints exist within the internal environment, and there is large task burden on the bedside nurse and respiratory therapist.
Conclusion(s): Video recording revealed variation in event timing and order during CDH resuscitations. Preparation, including equipment layout, is essential given room and bed spatial constraints. Nurses and respiratory therapists have numerous essential tasks during CDH resuscitation, making their skill and task prioritization critical to effective resuscitation. Standardization of room set-up, standardization of event order, and off-loading tasks to other providers represent potential targets for CDH DR improvement initiatives. This work emphasizes the importance of rigorous human factors review of DR resuscitation to identify areas for improvement.
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