Abstract
BACKGROUND: The Neonatal Resuscitation Program (NRP) standardizes the steps needed during resuscitation of newborns. However, there are no recommendations on how to organize equipment to minimize errors or improve ergonomics. Adult and pediatric studies used large, comprehensive “code carts” and reported increases in speed of retrieval. However, this has not been studied with equipment sets used in the delivery room. OBJECTIVES: To compare performance in retrieving and using basic neonatal resuscitation equipment from an ergonomic equipment box versus a standard equipment bag in simulated scenarios. DESIGN/METHODS: NRP trained healthcare professionals (HCP) were recruited from a tertiary Neonatal Intensive Care Unit. Using a crossover design, participants were randomized to two simulated neonatal resuscitation scenarios (use of standard equipment bag followed by ergonomic equipment box and visa versa). The scenarios were video recorded to analyze the time needed to i) perform four equipment related tasks and ii) to complete the entire scenario. In a pilot trial a mean of 180s was needed to complete a scenario. Thirty participants were required to detect a 10% difference with a power of 0.8 and a significance of 0.05. Statistical analysis was performed using a paired t-test. A post-simulation survey examined user preference. RESULTS: We randomized 30 HCPs and observed four protocol violations (missing equipment), leaving 26 for analysis. Combined, HCPs had a mean scenario time of 192.6 ± 20.2s with the equipment bag and 176.1 ± 21.6s with the box, a difference of 16.5s (p<0.0001). HCPs (n=12) randomized to equipment bag followed by equipment box had a mean scenario time of 193.2 ± 16.1s and 163.7 ± 14.1s, respectively. Using the box, participants were faster by 29.5s (p<0.0001). In comparison, HCPs (n=14) randomized to equipment box then equipment bag had similar mean times of 186.7 ± 21.6s and 192.1 ± 23.7s, respectively. This likely represents a balance between the superiority of the box and the rehearsal effect of the second scenario. The post-simulation survey revealed preference by all participants for the equipment box. CONCLUSION: During neonatal resuscitation simulation, HCPs were able to retrieve equipment more quickly when it was ergonomically organized. Despite a lack of familiarity, all participants preferred the equipment box. Neonatal resuscitation equipment should be organized ergonomically to improve performance.(Fig 9, 10)