An intervention to improve the work system of neonatal resuscitation teams

Abstract

Background: Neonatal resuscitation teams face unique challenges in the delivery of patient care. Our purpose was (a) to understand team challenges and then (b) to improve the work system. Methods: The user-centred design process involved multiple iterations of requirements gathering, prototype design, evaluation, and redesign. Methods included (1) field observations, (2) interviews with neonatologists (n = 3) and neonatal nurses (n = 4), (3) tabletop evaluations with neonatal clinicians (N = 7), and (4) in-situ simulations (N = 12). Results: The intervention comprised the following four prototypes: (1) a four-page resuscitation recording form; (2) a procedural shelf attachment for the resuscitation trolley that provides additional space for sterile procedures; (3) an equipment turntable that allocates equipment layout into four sections that correspond with the steps of resuscitation; and (4) an A3-size display of the neonatal resuscitation algorithm. Simulation-based testing showed a moderate-to-high usability rating of 79.2 on the SUS (system usability scale). Conclusions: A multi-method approach provided (a) novel insight into ‘work as done’ challenges and (b) an intervention designed to address challenges within the work system. This project is an example of a systematic approach to quality improvement in a complex clinical work environment. Subsequent phases will evaluate the prototypes on teamwork and clinical performance measures.

Keywords

• Human factors
• User-centred design
• Teams
• Work system
• Cognitive aids
• Simulation