PC1047: Impact of Team Size and Designated Recorder Role During Neonatal Resuscitation, a Randomized Trial

Background: During neonatal resuscitation, a team of healthcare providers (HCPs) must perform technical and cognitive tasks while working under intense time pressure. The complexity of this can lead to deviations from the Neonatal Resuscitation Program (NRP) algorithm, especially when performing advanced interventions. Studies have found up to a 54% noncompliance rate in NRP steps among NRP-trained teams attending high-risk resuscitations. Decision support tools and coaching have been shown to improve team performance in critical, team-based resuscitation environments.

Methods: The purpose of this study was to determine the optimal neonatal resuscitation team composition. Expert resuscitation teams performed simulated neonatal resuscitations. We used a 2x2 factorial design that randomized “hands-on” HCPs into teams of 4 or 5 and into having a “hands-off” recorder present or not. The recorder documented interventions on one tablet while a second tablet was visible to the hands-on team and displayed important times (figure 1). The recorder also acted as a time coach and prompted the team when it was time to check a heart rate, both after the initiation of chest compressions and after epinephrine was administered. Our sample size was 64 teams. Two-factor ANOVA was used to examine the effect of an additional team member, a recorder, and the interaction between these two factors. Our primary outcome was cumulative time error, which is the number of seconds that actions deviate from the ideal times in NRP guidelines. Secondary outcomes were overall team performance as assessed by the neonatal resuscitation performance evaluation (NRPE) score and time to first dose of IV epinephrine.

Results: Teams with a recorder had a significantly lower cumulative time error compared to teams without a recorder (67.7±45.4 vs 180.1±128.3 sec, mean±SD, p< 0.001, figure 2). There was no significant difference in cumulative time error between teams with and without an additional team member (figure 2). There was no difference in NRPE score or time to first dose of epinephrine in either of the groups.

Conclusion: The addition of a designated recorder decreases cumulative time error while an additional hands-on team member does not. Team compliance with the prompted interventions was significantly improved with the presence of a designated recorder. This demonstrates the utility of a time coach, and the designated recorder role should be expanded to provide prompts for other critical steps in the NRP algorithm with which teams struggle to comply.