The Iowa hospital visitation program: does outreach education affect management of neonatal resuscitation?

Thirty-nine Iowa hospitals were visited by a perinatal education team to improve management of neonatal resuscitation. Patient care was evaluated by reviewing medical records according to pre-established performance standards. Following patient-care review, educational programs were offered to physicians and nurses. The hospitals were first visited from July 1982 until June 1984. Follow-up visits were made during the next two years. Management of neonates born in meconium was initially inadequate, but improved during the second period. Similarly, the conduct of other neonatal care practices showed statistically significant improvement over time (including assisted ventilation, hypoglycemia screening, cardiac massage, temperature maintenance, and record documentation). Only treatment of hypoglycemia failed to show significant change. We discuss why a cause and effect relationship cannot be claimed even though the desired effect of the educational intervention was achieved.