Innovative concept in hospital teamwork
By Sharon Gray
(L-R) Resuscitation respiratory therapists Colleen Stacey and Melissa Keeping; neonatologist Dr. Khalid Aziz (behind); Mary Baker, division manager; Dr. Wayne Andrews, neonatologist; and resuscitation nurses Christine Angelopoulos and Lisa Goodyear (Photo by HSIMS)
Under the leadership of Faculty of Medicine neonatologists, a successful study has shown that a nurse-respiratory therapist Neonatal Resuscitation Team can effectively handle moderate-risk deliveries.
The Division of Newborn Medicine of the Health Care Corporation of St. John’s and MUN Faculty of Medicine neonatologists (specialists in newborn medicine) won a Best Practice Display award for 2004 from the Ontario Hospital Association on the development of a multidisciplinary Neonatal Resuscitation Team at a tertiary perinatal centre. The award was sponsored by Healthcare Quarterly.
“This is quite a prestigious award,” said Dr. Khalid Aziz, associate professor of pediatrics, noting that developing an interdisciplinary resuscitation team went against the accepted wisdom that neonatal resuscitation should always be overseen by an attending pediatrician/neonatologist.
The innovative concept transferred the role of neonatal resuscitation for all low and most medium-risk deliveries from the attending neonatologist to a team consisting of a neonatal nurse, a respiratory therapist and, when available, a resident, clinical associate or nurse practitioner.
Training of the team began in May 2001 at the Janeway Hospital and over 24 months the team attended moderate and high-risk deliveries, while low-risk deliveries remained largely the responsibility of trained delivery room staff. In the case of high-risk deliveries, a neonatologist was in attendance. Over the two-year period the team attended about 65 per cent of deliveries, most in advance of delivery. There were no neonatal deaths or morbidities related to resuscitation in the low or moderate-risk groups.
Dr. Aziz said that implementation of the Neonatal Resuscitation Team had a dramatic effect on attending physician workload. “We went from attendance at over 50 per cent of deliveries prior to the team implementation to less than 10 per cent after.”
Dr. Aziz said the study showed that assignment of level of risk provides a safe means of delivering neonatal resuscitation services, facilitating the Neonatal Resuscitation Team attendance at the majority of deliveries that required resuscitation. “The team can perform safely and effectively in a tertiary perinatal centre like the Janeway with off-site support from experienced neonatal staff at high-risk deliveries only.”
A paper authored by Khalid Aziz, Mairi Chadwick, Geoff Downton, Mary Baker and Wayne Andrews on the development and implementation of a multidisciplinary neonatal resuscitation team in a Canadian perinatal centre is in press for Resuscitation.