scholarly journals Assessment of Healthcare Provider Workload in Neonatal Resuscitation

2020 ◽  
Vol 8 ◽  
Author(s):  
Emily C. Zehnder ◽  
Brenda H. Y. Law ◽  
Georg M. Schmölzer
Keyword(s):  
Chest Compression ◽  
Human Error ◽  
Healthcare Providers ◽  
Neonatal Resuscitation ◽  
Interquartile Range ◽  
Delivery Room ◽  
Positive Pressure ◽  
Mental Demand ◽  
Perceived Workload ◽  
Nasa Tlx

Objective: Human errors or protocol deviations during neonatal resuscitation are common. Excess workload has been proposed as a contributor to human error during medical tasks. We aim to characterize healthcare providers' perceived workload during neonatal resuscitation.Design: Perceived workload was measured using a multi-dimensional retrospective National Aeronautics and Space Administration Task Load Index (NASA TLX) survey. The NASA TLX collects data on mental, physical, and temporal demand, performance, effort, and frustration. Each section is rated independently by participants on a scale of 0–20 (0 being lowest and 20 being highest). The Raw-TLX score is a composite score of all dimensions and presented on a scale of 0–100. Healthcare providers complete a paper and pencil survey after attending delivery room resuscitations within 3 months.Setting: Level three neonatal intensive care unit at the Royal Alexandra Hospital, Edmonton, AB, Canada.Participants: All neonatal healthcare providers who attended deliveries.Exposure: Participation in the delivery room care of newborns.Measurement: Raw TLX scores as a measure of overall workload and scores for each dimension of workload.Main Results: During the study period, ~880 neonatal resuscitation events occurred, and a total of 204 surveys were completed. Healthcare providers completed one survey for 179 deliveries, two surveys for 20 deliveries, and three surveys for 5 deliveries. The mean (standard deviation) gestational age was 35 (5) weeks, and the median (interquartile range) birth weight was 2,690 (1,830–3,440) g. Interventions at delivery were (i) stimulation 149 (73%), suction 130 (64%), continuous positive airway pressure 120 (59%), positive pressure ventilation 105 (52%), intubation 33 (16%), chest compression 10 (5%), and epinephrine 4 (2%). The overall median (interquartile range) Raw-TLX was 34 (18–49). The scores varied by dimension with mental demand 10 (5–14), physical demand 4 (1–6), temporal demand 8 (3–14), performance 4 (2–6), effort 8 (4–13), and frustration 4 (1–10). Raw-TLX scores were higher when healthcare providers performed any intervention compared to no intervention [35 (22–49) vs. 8 (6–18), p = 0.0011]; intubation and no intubation was [55 (46–62) vs. 30 (17–46), p = 0.0001], and between performing chest compression vs. no chest compression [55 (49–64) vs. 33 (18–47), p = 0.001].Conclusion: Perceived workload of neonatal healthcare providers increases during higher acuity deliveries. Healthcare providers' workload during neonatal resuscitation can be measured using NASATLX and was inversely associated with 5-min Apgar score. Future studies assessing healthcare providers' perceived workload during neonatal resuscitation in different settings are warranted.

Assessment of perceived workload in academic health center community pharmacies before and after implementation of a central call center

2019 ◽  
Vol 76 (21) ◽  
pp. 1794-1805 ◽  
Author(s):  
Laurel Legenza ◽  
Nancy A Nickman ◽  
Frank A Drews ◽  
Matthew Rim ◽  
Jeremy Tigh ◽  
...  
Keyword(s):  
Health Center ◽  
Call Center ◽  
Academic Health Center ◽  
Community Pharmacies ◽  
Academic Health ◽  
Physical Demand ◽  
Mental Demand ◽  
Before And After ◽  
Perceived Workload ◽  
Nasa Tlx

Abstract Purpose Results of a study to determine whether reducing pharmacy phone call workload through implementation of a pharmacy services call center (PSCC) led to decreased employee workload, improved efficiency, and increased pharmacist availability for patient care are reported. Methods A pre–post study was conducted using the NASA Task Load Index (NASA-TLX) instrument. Pharmacists, pharmacy technicians at 7 academic health center community pharmacies, and PSCC staff provided NASA-TLX data over 5 days during 3 data collection periods before and after PSCC implementation. Perceived workload was measured as an overall workload score (OWS) and mean scores for 6 NASA-TLX workload dimensions (mental demand, physical demand, temporal demand, performance, effort, and frustration). Results Relative to pre-PSCC values, mean postimplementation OWS scores significantly decreased in all 7 pharmacies (from 33.3 to 29.1 overall, p < 0.001) but especially in small pharmacies (from 31.7 to 27.6, p < 0.001). Scores for the physical demand and frustration dimensions were low in both the PSCC and in the 7 pharmacies, while scores for the performance dimension remained high (range, 6.8–8.3). In general, scores for all other measured NASA-TLX dimensions decreased after PSCC implementation, more so at smaller pharmacies. The PSCC staff mean OWS score increased over time (from 26.8 to 28.6, p < 0.0001) but remained near the overall pharmacy average of 29.1. Conclusion Use of the NASA TLX allowed for a direct subjective measurement of workload as perceived by pharmacy and PSCC employees before and after PSCC implementation. Long-term effects of the PSCC on workload should be assessed.

scholarly journals Pediatrics Residents' Preparedness for Neonatal Resuscitation Assessed Using High-Fidelity Simulation

2013 ◽  
Vol 5 (3) ◽  
pp. 399-404 ◽  
Author(s):  
Leandro Cordero ◽  
Brandon J. Hart ◽  
Rene Hardin ◽  
John D. Mahan ◽  
Peter J. Giannone ◽  
...  
Keyword(s):  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Neonatal Resuscitation ◽  
Delivery Room ◽  
Positive Pressure ◽  
High Fidelity ◽  
Procedural Skill ◽  
Actual Performance ◽  
Self Confidence ◽  
Skill Performance

Abstract Background Pediatrics residents are expected to demonstrate preparedness for neonatal resuscitation, yet research has shown gaps in residents' readiness to perform this skill. Objective To evaluate procedural skills and team performance of pediatrics residents during neonatal resuscitation (NR) using a high-fidelity mannequin, and to assess residents' confidence in their NR skills before and after training. Methods Two teams of residents (all had completed NR program training) participated in 2 separate, 90-minute sessions (2 to 3 weeks apart) in an off-site delivery room during their neonatal intensive care rotation. Residents' confidence in assisting and leading NR was surveyed before each session. Teams participated in a scenario (adapted from the NR program), which required 5 skills (positive pressure ventilation, chest compressions, endotracheal intubation, umbilical vein catheterization, and epinephrine administration). Video recording was used for debriefing and scoring. Skills were scored for technique and timeliness, and team behaviors were scored for communication, management, and leadership. Results Twenty-six residents (11 teams) completed 2 paired sessions. Self-confidence scores increased between the 2 sessions but were not correlated with performance. Gaps in procedural skill performance were observed, and timeliness for most skills did not meet expectations. Significant improvement in team communication was noted. Conclusions Important gaps in procedural skill performance, particularly timeliness, were detected by NR simulation training; residents' improvements in self-confidence did not reflect gains in actual performance. Their relative unpreparedness for NR (despite prior certification) highlights the need for deliberate practice and specific team training before and during neonatal intensive care delivery room rotations.

scholarly journals Impact of personal protective equipment on neonatal resuscitation procedures: a randomised, cross-over, simulation study

2021 ◽  
pp. fetalneonatal-2021-322216
Author(s):  
Francesco Cavallin ◽  
Fiorenzo Lupi ◽  
Benedetta Bua ◽  
Marion Bellutti ◽  
Alex Staffler ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Personal Protective Equipment ◽  
Healthcare Providers ◽  
Neonatal Resuscitation ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Positive Pressure ◽  
Protective Equipment ◽  
Chest Compressions ◽  
Randomised Controlled

Background and objectiveHealthcare providers should use personal protective equipment (PPE) when performing aerosol-generating medical procedures during highly infectious respiratory pandemics. We aimed to compare the timing of neonatal resuscitation procedures in a manikin model with or without PPE for prevention of SARS-COVID-19 transmission.MethodsA randomised controlled cross-over (AB/BA) trial of resuscitation with or without PPE in a neonatal resuscitation scenario. Forty-eight participants were divided in 12 consultant–nurse teams and 12 resident–nurse teams. The primary outcome measure was the time of positive pressure ventilation (PPV) initiation. The secondary outcome measures were duration of tracheal intubation procedure, time of initiation of chest compressions, correct use of PPE and discomfort/limitations using PPE.ResultsThere were significant differences in timing of PPV initiation (consultant–nurse teams: mean difference (MD) 6.0 s, 95% CI 1.1 to 10.9 s; resident–nurse teams: MD 11.0 s, 95% CI 1.9 to 20.0 s), duration of tracheal intubation (consultant–nurse teams: MD 22.0 s, 95% CI 7.0 to 36.9 s; resident–nurse teams: MD 9.1 s, 95% CI 0.1 to 18.1 s) and chest compressions (consultant–nurse teams: MD 32.3 s, 95% CI 14.4 to 50.1 s; resident–nurse teams: MD 9.1 s, 95% CI 0.1 to 18.1 s). Twelve participants completed the dressing after entering the delivery room. PPE was associated with visual limitations (43/48 participants), discomfort in movements (42/48), limitations in communication (32/48) and thermal discomfort (29/48).ConclusionsIn a manikin model, using PPE delayed neonatal resuscitation procedures with potential clinical impact. Healthcare workers reported limitations and discomfort when wearing PPE.Trial registration numberNCT04666233.

A-48 Examining the Relationship between Ethnicity, Perceived Workload, and Acculturation on Cordoba Naming Test Performance

2021 ◽  
Vol 36 (6) ◽  
pp. 1089-1089
Author(s):  
Isabel Munoz ◽  
Daniel W Lopez-Hernandez ◽  
Abril J Baez ◽  
Raymundo Cervantes ◽  
Raelynn B Munoz ◽  
...  
Keyword(s):  
Ethnic Groups ◽  
Test Performance ◽  
Future Research ◽  
Lexical Retrieval ◽  
Mental Demand ◽  
Confrontation Naming ◽  
Perceived Workload ◽  
Nasa Tlx ◽  
The Relationship ◽  
Naming Test

Abstract Objective Confrontation naming tests are used to examine an individual’s lexical retrieval. We examined the relationship of perceived workload and acculturation in three ethnic groups’ Cordoba Naming Test (CNT) performance. Methods The sample consisted of 32 Latinx, 11 Caucasians, and 10 Asian; all neurologically and psychologically healthy residents. All participants completed the CNT and subscales of the Abbreviated Multidimensional Acculturation Scale (AMAS) in English. AMAS was used to measure acculturation and the NASA-Task Load Index (NASA TLX) measured perceived workload. Results The CNT showed that the Caucasian group outperformed the Latinx group, p = 0.024, ηp2 = 0.14. However, the Latinx group reported better CNT performance compared to the Caucasian group, p = 0.023, ηp2 = 0.14. No differences were found between groups on the AMAS. Finally, we found a significant relationship between CNT and NASA-TLX subscales (i.e., performance, mental demand, effort, frustration, & overall perceived workload) in the Latinx group, r = −0.562 to −0.398, p &lt; 0.05. Discussion Results showed the Latinx group demonstrated worse CNT performance compared to the Caucasian group. To our knowledge, this is the first study to evaluate confrontation naming performance in an ethnically diverse sample. Furthermore, we found the Latinx group reported a higher perceived performance on the CNT compared to Caucasians. Our results indicated a relationship between CNT performance and perceived workload in our Latinx sample as opposed to the Caucasian and Asian groups. Future research is needed with a larger sample size; moreover, additional research should investigate interactions between perceived workload, acculturation, and other cultural variables (e.g., bilingualism) in the interpretation of test performance in diverse ethnic groups.

Effects of Demand Transitions on Vigilance Performance and Perceived Workload

1995 ◽  
Vol 39 (21) ◽  
pp. 1375-1379 ◽  
Author(s):  
Brian W. Moroney ◽  
Joel S. Warm ◽  
William N. Dember
Keyword(s):  
Event Rate ◽  
Mental Workload ◽  
Task Demand ◽  
Experimental Session ◽  
Vigilance Performance ◽  
Mental Demand ◽  
Perceived Workload ◽  
Nasa Tlx ◽  
Low Levels ◽  
Upper Level

This study examined the effects of transitions in task demand on vigilance performance and perceived mental workload. Task demand was manipulated through variations in background event rate–the rate of cascade of neutral events which must be monitored in order to detect critical signals. As is typical in vigilance research, overall performance varied inversely with event rate in all phases of the study. The post-transition performance of observers shifted from a fast-to-slow event rate (high-to-low task demand) remained below that of their continuous slow event rate controls, and was thus unaffected by the shift. In contrast, the post-transition performance of monitors shifted in the opposite direction, slow-to-fast event rate, was affected by the shift. In this case, the performance of the shifted observers fell below that of their continuous fast event rate controls. These results challenge prior findings indicating that psychophysical contrast is the representative outcome of shifts in information-processing demand in vigilance tasks (Krulewitz, Warm, & Wohl, 1975). Consistent with previous findings, workload scores, as indexed by the NASA-TLX, fell at the mid-to-upper level of the scale. Shifted observers who experienced both high and low levels of task demand during the vigil showed differences in composite ratings on the Mental Demand subscale. These results serve to caution that workload measurements obtained through the NASA-TLX at the end of an experimental session containing variations in task demand do not simply reflect an averaging of the observer's demand experiences.

Does parental presence affect workload during neonatal resuscitation?

2020 ◽  
Vol 105 (5) ◽  
pp. 559-561
Author(s):  
Emily Zehnder ◽  
Brenda Hiu Yan Law ◽  
Georg M Schmölzer
Keyword(s):  
Healthcare Professionals ◽  
Healthcare Providers ◽  
Neonatal Resuscitation ◽  
Complete Information ◽  
Parental Presence ◽  
Task Load ◽  
Perceived Workload ◽  
Paper And Pencil ◽  
Work Supports

BackgroundParents often prefer being present during neonatal resuscitation and benefit from this experience. We aim to determine if parental presence during neonatal resuscitation affects the perceived workload of healthcare providers.MethodsPerceived workload was measured using the multidimensional retrospective National Aeronautics and Space Administration Task Load Index survey. Over 3 months, healthcare providers were asked to complete a paper and pencil survey following their participation in a neonatal resuscitation. Surveys also collected healthcare providers’ reports of parental presence during resuscitation.Results204 surveys were completed. Of these 183 (90%) had complete information about parental presence. Overall workload of healthcare professionals was significantly lower when at least one parent was present (33; 16–47) compared with when no parents were present (46; 29–57) during the resuscitation (p=0.0004).ConclusionThis work supports the presence of parents during neonatal resuscitation. Parental presence during neonatal resuscitation was associated with decreased overall workload experienced by healthcare providers.

scholarly journals El estilo de comunicación del entrenador como predictor de la carga de trabajo percibida en jóvenes futbolistas (Coach communication style as a predictor of perceived workload in young football players)

Retos ◽  
2021 ◽  
Vol 43 ◽  
pp. 868-874
Author(s):  
Roberto Silva Flores ◽  
Jaume Mas Riera ◽  
Alexandre Garcia-Mas
Keyword(s):  
Communication Style ◽  
Soccer Players ◽  
Communication Styles ◽  
Football Players ◽  
Managerial Communication ◽  
Mental Demand ◽  
Significant Difference ◽  
Perceived Workload ◽  
Nasa Tlx ◽  
Video And Audio

  El objetivo del presente trabajo fue conocer las implicaciones del estilo comunicativo del entrenador durante la realización de la actividad en la carga de trabajo percibida por jugadores jóvenes de fútbol. En el estudio participaron dos equipos de la categoría cadete, siendo un total de 32 jugadores (M = 15.19; SD = 0.39), y sus dos respectivos entrenadores. La recogida de datos tuvo lugar en dos entrenamientos diferentes, con un intervalo de una semana entre cada actividad. La carga de trabajo se midió mediante el NASA-TLX adaptado a la herramienta de Google Forms que los jugadores contestaron después de la actividad. Para analizar la comunicación del entrenador se utilizó la grabación en video y audio de la actividad para un posterior análisis a través de una adaptación del CBAS. Aunque los entrenadores presentan dos estilos comunicativos distintos, los resultados no muestran una diferencia significativa entre los dos equipos en la carga de trabajo percibida. Sin embargo, el estilo comunicativo directivo presenta una tendencia a una mayor exigencia mental, una mayor frustración y un menor rendimiento percibido.  Abstract. The aim of this study was to know the implications of the coach's communicative style during the performance of the activity on the workload perceived by young soccer players. Two teams from the cadet category participated in the study, with a total of 32 players (M = 15.19; SD = 0.39), and their two respective coaches. Data collection took place in two different workouts, with an interval of one week between each activity. The workload was measured using the NASA-TLX adapted to the Google Forms tool that the players answered after the activity. Regarding the analysis of the coach's communication, video and audio recording of the activity was used for subsequent analysis through an adaptation of CBAS. Although the coaches have two different communication styles, the results don’t show a significant difference between the two teams in perceived workload. However, the managerial communication style presents a trend towards greater mental demand, greater frustration and lower performance perceived.

Heart rate changes during positive pressure ventilation after asphyxia-induced bradycardia in a porcine model of neonatal resuscitation

2018 ◽  
Vol 104 (1) ◽  
pp. F98-F101 ◽  
Author(s):  
Maria Liza Espinoza ◽  
Po-Yin Cheung ◽  
Tze-Fun Lee ◽  
Megan O’Reilly ◽  
Georg M Schmölzer
Keyword(s):  
Heart Rate ◽  
Chest Compression ◽  
Positive Pressure Ventilation ◽  
Porcine Model ◽  
Neonatal Resuscitation ◽  
Positive Pressure ◽  
Term Newborn ◽  
Newborn Piglets ◽  
Severe Bradycardia ◽  
Neonatal Resuscitation Program

BackgroundThe Neonatal Resuscitation Program (NRP) states that if adequate positive pressure ventilation (PPV) was given for a low heart rate (HR), the infant’s HR should increase within the first 15 s of PPV.ObjectiveTo assess changes in HR in piglets with asphyxia-induced bradycardia.MethodsTerm newborn piglets (n=30) were anaesthetised, intubated, instrumented and exposed to 50 min normocapnic hypoxia followed by asphyxia. Asphyxia was achieved by clamping the tube until severe bradycardia (defined as HR at <25% of baseline). This was followed by 30 s adequate PPV and chest compression thereafter. Changes in HR during the 30 s of PPV were assessed and divided into four epochs (0–10 s, 5–15 s, 10–20 s and 20–30 s, respectively).ResultsIncrease in HR >100/min was observed in 6/30 (20%) after 30 s of PPV. Within the epochs 0–10 s, 5–15 s or 10–20 s no piglet had an increase in HR >100/min. Additional 10/30 (33%) had a >10% increase in HR.ConclusionIn contrast to NRP recommendation, adequate PPV does not increase HR within 15 s after ventilation in piglets with asphyxia-induced bradycardia.

scholarly journals Impact of neonatal resuscitation changes on outcomes of very-low-birth-weight infants

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
So Jin Yoon ◽  
Joohee Lim ◽  
Jung Ho Han ◽  
Jeong Eun Shin ◽  
Ho Seon Eun ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Periventricular Leukomalacia ◽  
Neonatal Resuscitation ◽  
Delivery Room ◽  
Positive Pressure ◽  
Low Birth Weight Infants ◽  
International Consensus ◽  
Risk Of Mortality

AbstractThe improvement of delivery room care, according to the 2015 International Consensus, may affect neonatal outcome, especially in very-low-birth-weight infants. We aimed to investigate the current practice of neonatal resuscitation by year and analyze the association with neonatal outcomes. A total of 8142 very-low-birth-weight infants, registered in the Korean Neonatal Network between 2014 and 2017 were included. A significant decreasing trend of intubation (64.5% vs 55.1%, P < 0.0001) and markedly increasing trend of positive pressure ventilation (PPV) (11.5% vs 22.9%, P < 0.0001) were noted. The annual PPV rate differed significantly by gestation (P < 0.0001). The highest level of resuscitation was also shown as an independent risk factor for mortality within 7 days and for bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), and periventricular leukomalacia. PPV and intubation were associated with significantly decreased risk of mortality and morbidities compared to epinephrine use. When considering association, the incidence of mortality within 7 days, IVH, PVL, and BPD or mortality showed significant differences by combination of year, gestational age, and level of resuscitation. According to updated guidelines, changes in the highest level of resuscitation significantly associated with reducing mortality and morbidities. More meticulous delivery room resuscitation focusing on extreme prematurity is needed.

scholarly journals Is Chest Compression Superimposed with Sustained Inflation during Cardiopulmonary Resuscitation an Alternative to 3:1 Compression to Ventilation Ratio in Newborn Infants?

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 97
Author(s):  
Seung Yeon Kim ◽  
Gyu-Hong Shim ◽  
Georg M. Schmölzer
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Newborn Infants ◽  
Neonatal Resuscitation ◽  
Spontaneous Circulation ◽  
Delivery Room ◽  
Sustained Inflation ◽  
Resuscitation Guidelines ◽  
High Incidence ◽  
Reduced Time

Approximately 0.1% for term and 10–15% of preterm infants receive chest compression (CC) in the delivery room, with high incidence of mortality and neurologic impairment. The poor prognosis associated with receiving CC in the delivery room has raised concerns as to whether specifically-tailored cardiopulmonary resuscitation methods are needed. The current neonatal resuscitation guidelines recommend a 3:1 compression:ventilation ratio; however, the most effective approach to deliver chest compression is unknown. We recently demonstrated that providing continuous chest compression superimposed with a high distending pressure or sustained inflation significantly reduced time to return of spontaneous circulation and mortality while improving respiratory and cardiovascular parameters in asphyxiated piglet and newborn infants. This review summarizes the current available evidence of continuous chest compression superimposed with a sustained inflation.

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