title: Evaluation of Heart Rate Assessment Timing, Communication, Accuracy, and Clinical Decision-Making during High Fidelity Simulation of Neonatal Resuscitation.
abstract: Objective. Accurate heart rate (HR) determination during neonatal resuscitation (NR) informs subsequent NR actions. This study's objective was to evaluate HR determination timeliness, communication, and accuracy during high fidelity NR simulations that house officers completed during neonatal intensive care unit (NICU) rotations. Methods. In 2010, house officers in NICU rotations completed high fidelity NR simulation. We reviewed 80 house officers' videotaped performance on their initial high fidelity simulation session, prior to training and performance debriefing. We calculated the proportion of cases congruent with NR guidelines, using chi square analysis to evaluate performance across HR ranges relevant to NR decision-making: <60, 60-99, and ≥100 beats per minute (bpm). Results. 87% used umbilical cord palpation, 57% initiated HR assessment within 30 seconds, 70% were accurate, and 74% were communicated appropriately. HR determination accuracy varied significantly across HR ranges, with 87%, 57%, and 68% for HR <60, 60-99, and ≥100 bpm, respectively (P < 0.001). Conclusions. Timeliness, communication, and accuracy of house officers' HR determination are suboptimal, particularly for HR 60-100 bpm, which might lead to inappropriate decision-making and NR care. Training implications include emphasizing more accurate HR determination methods, better communication, and improved HR interpretation during NR.
authors.affiliation: Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: Win
authors.identifier: 0000-0001-8568-1914
authors.initials: W
authors.lastname: Boon
authors.affiliation: Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: McAllister
authors.affiliation: Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Attar
authors.affiliation: Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Chapman
authors.affiliation: Department of Medical Education, University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: Patricia B
authors.initials: PB
authors.lastname: Mullan
authors.affiliation: Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI 48109, USA ; Department of Medical Education, University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: Hilary M
authors.initials: HM
authors.lastname: Haftel