6410 Fannin St, UPB 1100, Houston, TX 77030, USA.
Pediatrics. 2010 Mar;125(3):539-46. doi: 10.1542/peds.2009-1635. Epub 2010 Feb 15.
Poor communication and teamwork may contribute to errors during neonatal resuscitation. Our objective was to evaluate whether interns who received a 2-hour teamwork training intervention with the Neonatal Resuscitation Program (NRP) demonstrated more teamwork and higher quality resuscitations than control subjects.
Participants were noncertified 2007 and 2008 incoming interns for pediatrics, combined pediatrics and internal medicine, family medicine, emergency medicine, and obstetrics and gynecology (n = 98). Pediatrics and combined pediatrics/internal medicine interns were eligible for 6-month follow-up (n = 34). A randomized trial was conducted in which half of the participants in the team training arm practiced NRP skills by using high-fidelity simulators; the remaining practiced with low-fidelity simulators, as did control subjects. Blinded, trained observers viewed video recordings of high-fidelity-simulated resuscitations for teamwork and resuscitation quality.
High-fidelity training (HFT) group had higher teamwork frequency than did control subjects (12.8 vs 9.0 behaviors per minute; P < .001). Intervention groups maintained more workload management (control subjects: 89.3%; low-fidelity training [LFT] group: 98.0% [P < .001]; HFT group: 98.8%; HFT group versus control subjects [P < .001]) and completed resuscitations faster (control subjects: 10.6 minutes; LFT group: 8.6 minutes [P = .040]; HFT group: 7.4 minutes; HFT group versus control subjects [P < .001]). Overall, intervention teams completed the resuscitation an average of 2.6 minutes faster than did control subjects, a time reduction of 24% (95% confidence interval: 12%-37%). Intervention groups demonstrated more frequent teamwork during 6-month follow-up resuscitations (11.8 vs 10.0 behaviors per minute; P = .030).
Trained participants exhibited more frequent teamwork behaviors (especially the HFT group) and better workload management and completed the resuscitation more quickly than did control subjects. The impact on team behaviors persisted for at least 6 months. Incorporating team training into the NRP curriculum is a feasible and effective way to teach interns teamwork skills. It also improves simulated resuscitation quality by shortening the duration.
沟通不良和团队协作不佳可能是新生儿复苏过程中出现错误的原因之一。我们的目的是评估接受新生儿复苏方案（NRP）2 小时团队培训干预的实习医生是否比对照组表现出更多的团队协作和更高质量的复苏。
参与者为未获得儿科认证的 2007 年和 2008 年新入职的儿科、儿科与内科联合、家庭医学、急诊医学和妇产科实习医生（n=98）。儿科和儿科与内科联合实习医生有资格进行 6 个月的随访（n=34）。进行了一项随机试验，其中团队培训组的一半参与者使用高保真模拟器练习 NRP 技能，其余参与者使用低保真模拟器练习，对照组也是如此。经过培训的盲眼观察者观看高保真模拟复苏的视频记录，以评估团队合作和复苏质量。
高保真培训（HFT）组的团队协作频率高于对照组（每分钟 12.8 次与 9.0 次；P<0.001）。干预组保持了更好的工作量管理（对照组：89.3%；低保真培训[LFT]组：98.0%[P<0.001]；HFT 组：98.8%；HFT 组与对照组相比[P<0.001]），并且复苏速度更快（对照组：10.6 分钟；LFT 组：8.6 分钟[P=0.040]；HFT 组：7.4 分钟；HFT 组与对照组相比[P<0.001]）。总体而言，干预组完成复苏的平均时间比对照组快 2.6 分钟，时间缩短了 24%（95%置信区间：12%-37%）。干预组在 6 个月的随访复苏中表现出更频繁的团队协作（每分钟 11.8 次与 10.0 次；P=0.030）。
接受培训的参与者表现出更频繁的团队协作行为（尤其是 HFT 组），更好的工作量管理，并且比对照组更快地完成复苏。这种团队行为的影响至少持续了 6 个月。将团队培训纳入 NRP 课程是向实习医生教授团队协作技能的一种可行且有效的方法。它还通过缩短复苏时间来提高模拟复苏质量。
