Thomas Alyssa R, Bowen Caitlin, Abdulhayoglu Elisa, Brennick Elizabeth, Woo Kendra, Everett Margaret F, Valencia Eleonore, Leeman Kristen T, Manning Simon M, Kaza Elisabeth
Division of Newborn Medicine, Department of Pediatrics, Brigham & Women's Hospital, Boston, MA, USA.
Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.
J Perinatol. 2024 Dec 10. doi: 10.1038/s41372-024-02196-8.
Newborns with critical congenital heart disease (CCHD) require specialized delivery room management, but varying experience and knowledge can reduce confidence and impact care.
A pre-delivery, structured huddle checklist was introduced, addressing team roles, expected physiology, and management plans. PDSA cycles incorporated guidelines and simulation-based education to improve confidence in specialized resuscitation strategies. Surveys were conducted at baseline and 6 months.
Baseline, all-respondent confidence in managing "all types of CCHD" was somewhat confident (median 3/5; IQR 2-4) increasing to moderately confident (4/5; IQR 2-4) at 6 months (p = 0.59). Respondents with 0-3 years' experience showed increased confidence over 6 months in identifying unstable infants (from baseline 24% to 67% moderately/very confident, p = 0.005), prostaglandin E1 needs (from 24% to 62%, p = 0.013) and sedation requirements (from 5% to 33%, p = 0.045).
Structured huddles improved confidence among less experienced team members, emphasizing the importance of shared mental models before CCHD deliveries.
患有严重先天性心脏病（CCHD）的新生儿需要在产房进行专门管理，但经验和知识的差异会降低信心并影响护理。
引入了分娩前结构化碰头检查表，涉及团队角色、预期生理状况和管理计划。计划-执行-检查-行动（PDSA）循环纳入了指南和基于模拟的教育，以提高对专门复苏策略的信心。在基线和6个月时进行了调查。
基线时，所有受访者对管理“所有类型的CCHD”的信心为“有些信心”（中位数3/5；四分位间距2 - 4），6个月时增至“中等信心”（4/5；四分位间距2 - 4）（p = 0.59）。经验在0至3年的受访者在6个月内对识别不稳定婴儿（从基线时24%增至67%中等/非常有信心，p = 0.005）、前列腺素E1需求（从24%增至62%，p = 0.013）和镇静需求（从5%增至33%，p = 0.045）的信心有所增加。
结构化碰头提高了经验较少的团队成员的信心，强调了在CCHD分娩前共享心理模型的重要性。
