title: Identifying improvements for delivery room resuscitation management: results from a multicenter safety audit.
abstract: BACKGROUND
  Stabilization and resuscitation of a newborn infant is a complex activity that involves multiple team members. Neonatal intensive care units (NICU) participating in the Vermont Oxford Network (VON) iNICQ 2012 quality improvement collaborative reported on delivery room care policies and guidelines and submitted information on up to 10 consecutive deliveries attended by NICU team members. Teams received immediate feedback on their local performance and a summary of results from all participating units for use in quality improvement planning.
  
  
  RESULTS
  Most of the 84 NICU teams that participated in the audit had policies or guidelines about which deliveries required NICU team attendance (83%), personnel who should attend (81%), and their required training (79%). Fewer had policies about briefing prior to the delivery (8%), debriefing after delivery (6%), or communicating with family members (10%). Eighty-one percent of NICUs reported using simulation-based resuscitation training, 14% used a safety checklist, and 2% videotaped deliveries for review. Of the 609 audited deliveries, 88% had team member attendance that conformed to unit policy, 66% had a briefing before delivery, 19% had a debriefing after delivery, and 92% had family communication occur within 30 minutes.
  
  
  CONCLUSIONS
  NICU teams can improve the quality and safety of delivery room care by implementing formal tools designed to facilitate teamwork such as briefings, debriefings, checklists, and videotape reviews. Rapid online audits are effective methods for helping teams identify opportunities for improvement.
authors.affiliation: Vermont Oxford Network, Burlington, VT USA ; Department of Mathematics and Statistics, University of Vermont, Burlington, VT USA.
authors.forename: Erika M
authors.initials: EM
authors.lastname: Edwards
authors.affiliation: Vermont Oxford Network, Burlington, VT USA ; Department of Pediatrics, University of Vermont, Burlington, VT USA.
authors.forename: Roger F
authors.initials: RF
authors.lastname: Soll
authors.affiliation: Vermont Oxford Network, Burlington, VT USA.
authors.forename: Karla
authors.initials: K
authors.lastname: Ferrelli
authors.affiliation: Vermont Oxford Network, Burlington, VT USA.
authors.forename: Kate A
authors.initials: KA
authors.lastname: Morrow
authors.affiliation: Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, NH USA.
authors.forename: Gautham
authors.initials: G
authors.lastname: Suresh
authors.affiliation: Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, NH USA.
authors.forename: Joanna
authors.initials: J
authors.lastname: Celenza
authors.affiliation: Vermont Oxford Network, Burlington, VT USA ; Department of Pediatrics, University of Vermont, Burlington, VT USA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Horbar
keywords: Cooperative behavior; Delivery rooms; Infant; Newborn; Patient care team/organization & administration; Premature; Resuscitation