Variation in optimal communication modes during neonatal resuscitation

Effective communication is paramount for neonatal resuscitation. Best practices emphasize clear, coordinated team communication. High-performing teams use both routine and critical communication modes, adjusting their approach as acuity evolves. However, the degree to which interprofessional neonatal intensive care unit (NICU) teams share an understanding of when each mode is optimal is unknown.

We conducted a cross-sectional study of NICU providers participating in a team-development day at a large children's hospital. After an instructional session defining routine and critical communication, participants reviewed a hypothetical unplanned extubation and cardiac arrest scenario including 14 steps split into pre-code, code, and post-code phases. Participants rated optimal mode of team communication for each step using a 5-point Likert scale. Consensus was defined as ≥60% agreement on communication mode for each step. We compared physicians and non-physicians across scenario phases.

Forty-eight providers participated, representing physicians, nurses, advanced practice providers, and respiratory therapists. Participants reached consensus on all code phase steps, selecting critical communication. No consensus was achieved for pre-code or post-code. Physicians selected more critical communication than non-physicians during the pre-code phase (median 4.0 vs 3.0, p = 0.001) with no differences during code or post-code.

Providers within a cohesive NICU team showed divergent mental models regarding optimal communication during early and late phases of a hypothetical resuscitation. This heterogeneity may hinder rapid team alignment and represent an important target for quality-improvement efforts. Future work should evaluate communication during real resuscitations and develop strategies to support shared communication expectations across roles.