title: Real-time video communication improves provider performance in a simulated neonatal resuscitation.
abstract: OBJECTIVE
  To determine if a real-time audiovisual link with a neonatologist, termed video-assisted resuscitation or VAR, improves provider performance during a simulated neonatal resuscitation scenario.
  
  
  METHODS
  Using high-fidelity simulation, 46 study participants were presented with a neonatal resuscitation scenario. The control group performed independently, while the intervention group utilized VAR. Time to effective ventilation was compared using Wilcoxon rank sum tests. Providers' use of the corrective steps for ineffective ventilation per the NRP algorithm was compared using Cochran-Armitage trend tests.
  
  
  RESULTS
  The time needed to establish effective ventilation was significantly reduced in the intervention group when compared to the control group (mean time 2 min 42 s versus 4 min 11 s, p<0.001). In the setting of ineffective ventilation, only 35% of control subjects used three or more of the first five corrective steps and none of them used all five steps. Providers in the control group most frequently neglected to open the mouth and increase positive pressure. In contrast, all of those in the intervention group used all of the first five corrective steps, p<0.001. All participants in the control group decided to intubate the infant to establish effective ventilation, compared to none in the intervention group, p<0.001.
  
  
  CONCLUSIONS
  Using VAR during a simulated neonatal resuscitation scenario significantly reduces the time to establish effective ventilation and improves provider adherence to NRP guidelines. This technology may be a means for regional centers to support local providers during a neonatal emergency to improve patient safety and improve neonatal outcomes.
authors.affiliation: Division of Neonatal Medicine, Mayo Clinic, 200 1st Street S.W., Rochester, MN 55905, United States.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Fang
authors.affiliation: Division of Neonatal Medicine, Mayo Clinic, 200 1st Street S.W., Rochester, MN 55905, United States.
authors.forename: William A
authors.initials: WA
authors.lastname: Carey
authors.affiliation: Division of Neonatal Medicine, Mayo Clinic, 200 1st Street S.W., Rochester, MN 55905, United States.
authors.forename: Tara R
authors.initials: TR
authors.lastname: Lang
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 1st Street S.W., Rochester, MN 55905, United States.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Lohse
authors.affiliation: Division of Neonatal Medicine, Mayo Clinic, 200 1st Street S.W., Rochester, MN 55905, United States. Electronic address: colby.christopher@mayo.edu.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Colby
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003142:Communication; D003198:Computer Simulation; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007396:Internship and Residency; D007400:Interprofessional Relations; D008297:Male; D009359:Neonatology / Q000193:education; D010348:Patient Care Team; D012016:Reference Values; D012151:Resuscitation / Q000193:education*; D017216:Telemedicine / Q000379:methods; D014741:Video Recording
keywords: Neonatal resuscitation program (NRP); Neonate; Simulation; Telemedicine; Video-assisted resuscitation (VAR)