Neonatal resuscitation: toward improved performance.
BACKGROUND
As part of a continuous quality assurance process which we instituted in 1999, we review videotapes of selected high-risk deliveries at our hospital. We utilized our reviews to evaluate the occurrence of errors, and to evaluate team and leader functions during neonatal resuscitation.


METHODS
We established accepted behavior for members of resuscitation teams and the team leader. The actual conduct of the resuscitation was judged against the standard of the guidelines of the Neonatal Resuscitations Program of the American Heart Association, and the American Academy of Pediatrics. The videotapes of resuscitations were reviewed, and significant deviations from accepted practices were noted, and discussed by a specifically developed quality assurance committee, including, whenever possible, the actual resuscitators.


RESULTS
We were able to detect a number of problems, which included inappropriate leader and team member activities, inappropriate preparation, communication, and coordination, and made a number of changes to our practice.


CONCLUSIONS
We believe that neonatal resuscitation may be improved by the provision of teaching about team and leader functions, encouraging debriefing following complicated resuscitations, developing a minimal form to be completed for any patient requiring compressions or epinephrine within the delivery room, and providing more direct observations regarding the actual conduct of resuscitation.
Finer
Neil N
NN
Division of Neonatology, Department of Pediatrics, University of California San Diego Medical Center, 200 W. Arbor Drive, 8774, San Diego, CA 92103-8774, USA. nfiner@ucsd.edu
Rich
Wade
W
D001238:Asphyxia Neonatorum / Q000628:therapy*; D016887:Cardiopulmonary Resuscitation; D019983:Guideline Adherence; D006801:Humans; D007231:Infant, Newborn; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D014741:Video Recording