Situation Awareness in Neonatal Resuscitation Requires Intentional System Design

We describe the necessity and application of situation awareness (SA) in the context of neonatal resuscitation. Neonatal resuscitation is a time-constrained, high-pressure situation requiring efficient team decision-making. In these moments, health care professionals benefit from team SA, coming together to synthesize real-time information through a shared mental model, predicting potential outcomes and adjusting clinical course for the best possible outcome. Leveraging literature on SA from human factors science as our foundational theory and comparing it to clinical and operational observations of neonatal resuscitation, we evaluate barriers to SA in this context. We examine previous studies on effective standards, simulation-based training, and debriefings in the context of neonatal resuscitation. We identify significant challenges to effective team SA in the current healthcare system, from out-of-sync health information systems to shifting neonatal resuscitation team roles to complex patients requiring immediate intervention. Improving neonatal resuscitation requires rethinking hospital systems to support pathways to complete team SA, including investments in real-time data on accessible in-delivery room monitors, predictive algorithms and decision support, simulation-based training with video debriefings, and standardized protocols. Increasing supportive systems for SA for neonatal resuscitation could improve safety and effectiveness. · Neonatal resuscitation relies on strong team situational awareness.. · Ineffective data systems, shifting clinician teams, and human factors bias are all barriers to team SA.. · Solutions include actionable data displays, simulation-based training, and standard protocols..