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Tablet-Based Decision Support Tool Improves Performance of Neonatal Resuscitation: A Randomized Trial in Simulation.

Charles M Roitsch1, Karen E Patricia, Joseph L Hagan

  • 1From the Section of Neonatology, Department of Pediatrics (C.M.R., K.E.P., J.L.H., N.C.S.), Baylor College of Medicine & Texas Children's Hospital, Houston, TX; and Center for Medical Simulation and Innovative Education (J.L.A.), Johns Hopkins All Children's Hospital, St. Petersburg, FL.

Simulation in Healthcare : Journal of the Society for Simulation in Healthcare
|March 14, 2020
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Summary

Tablet-based decision support tools (DST) improved Neonatal Resuscitation Program (NRP) algorithm adherence in simulated scenarios. Team size did not significantly impact adherence, suggesting DSTs are valuable for improving neonatal resuscitation compliance.

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Area of Science:

  • Medical simulation
  • Neonatal resuscitation
  • Clinical decision support

Background:

  • Neonatal Resuscitation Program (NRP) algorithm adherence is critical but challenging for healthcare teams.
  • Existing decision support tools (DSTs) lack sufficient testing in neonatal resuscitation.
  • Optimal team size for neonatal resuscitation remains undetermined.

Purpose of the Study:

  • To evaluate the impact of a tablet-based DST on NRP algorithm compliance.
  • To determine if team size (2 vs. 3 providers) affects NRP adherence.
  • To assess the interaction between DST use and team size in simulated neonatal resuscitations.

Main Methods:

  • 109 healthcare providers (HCPs) were randomized into teams of 2 or 3.
  • Participants used either a tablet-based DST or memory recall during simulated neonatal resuscitation.
  • NRP compliance was primary outcome, measured by the modified Neonatal Resuscitation Performance Evaluation (NRPE).

Main Results:

  • DST use significantly improved overall NRPE scores compared to memory alone (p = 0.015).
  • No significant difference in NRPE scores was found between 2- and 3-provider teams.
  • Cumulative time error decreased with DST use, though not significantly (p = 0.057); team size did not affect time error.

Conclusions:

  • DSTs enhance adherence to the NRP algorithm in simulated neonatal resuscitation.
  • Team size of 2 or 3 providers demonstrated similar performance.
  • Further clinical evaluation of DSTs in real-world neonatal resuscitation is recommended.