Abstract
Aim
Flow disruptions (FDs) are deviations from the progression of care that compromise
safety and efficiency of a specific process. The study aim was to identify the impact
of FDs during neonatal resuscitation and determine their association with key process
and outcome measures.
Methods
Prospective observational study of video recorded delivery room resuscitations of
neonates <32 weeks gestational age. FDs were classified using an adaptation of Wiegmann’s
FD tool. The primary outcome was target oxygenation saturation achievement at 5 min.
Secondary outcomes included achieving target saturation at 10 min, time to positive
pressure ventilation for initially apnoeic/bradycardic neonates, time to electrocardiogram
signal, time to pulse oximetry signal, and time to stable airway. Multivariable logistic
regression assessed association between FDs and achieving target saturations adjusting
for gestational age and leader. Associations between FDs and time to event outcomes
were assessed using Cox proportional hazards models.
Results
Between 10/2017–7/2018, 32 videos were included. A mean of 52.6 FDs (standard deviation
17.9) occurred per resuscitation. Extraneous FDs were the most common FDs. FDs were
associated with an adjusted odds ratio of 0.92 (95% confidence interval [CI] 0.80–1.05)
of achieving target saturation at 5 min and 0.94 (95% CI 0.84–1.05) at 10 min. There
was no significant evidence to show FDs were associated with time to event outcomes.
Conclusions
FDs occurred frequently during neonatal resuscitation. Measuring FDs is a feasible
method to assess the impact of human factors in the delivery room and identify modifiable
factors and practices to improve patient care.
Keywords
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Article info
Publication history
Published online: March 17, 2020
Accepted:
February 26,
2020
Received in revised form:
February 20,
2020
Received:
November 4,
2019
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
