Improving Delivery Room Preparedness for Pediatric Residents via Just in time Education and Checklist

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Background: It has been found that 10% of all babies born at term may require some assistance to initiate spontaneous respirations and 1% will require extensive resuscitation. NYU Langone- Long Island Hospital sees more than 5,000 births annually and pediatricians are present at a birth when deemed necessary. Outside of NRP certification at the beginning of PGY1 year, there is no formal education or "refresher" course for residents regarding delivery room preparation.  Literature tells us that skills and knowledge obtained in standardized courses deteriorate shortly after completion. Most residents do not rotate in the NICU immediately after NRP training. Residents rely on an informal and non-mandatory review of equipment and procedures with staff members ideally at the beginning of their rotation.

Objective: To improve resident preparedness for set-up in the delivery room by 10% with implementation of a just-in- time standardized education and checklist. Our secondary objective was to determine whether retention of the education lasted beyond the rotation.

Methods: Using NRP pre-resuscitation guidelines, we created a standardized curriculum and a checklist highlighting five major criteria for delivery room preparation. Each resident underwent a baseline evaluation on the proper set-up of the warmer. Following the initial evaluation, an in-person education session reviewing the checklist was conducted. Each resident was given a copy of the checklist and a PowerPoint summarizing the session. At the end of the rotation, each resident was re-evaluated using the same checklist. Each resident also filled out a post-rotation survey on their perception of overall preparedness for setting up for a delivery and confidence in the skills they reviewed during the live instruction.

Results: We implemented the standardized curriculum over the last four months and each resident rotating through the NICU received education prior to the start of their rotation. We evaluated eleven residents and observed a statistically significant improvement in performance on the post-rotation evaluation versus the pre-rotation evaluation for both PGY1 and PGY2 residents. On average, the percent improvement from baseline in PGY1 evaluation performance was 52.9% (p=0.0003) and in PGY2 residents the percent improvement was 17.6% (p=0.0138). For PGY1 trainees, there was increased confidence in delivery room set up after completion of the curriculum (P=0.0047).

Conclusions: The implementation of a standardized curriculum and checklist improved overall resident preparedness for delivery room readiness as well as confidence in skillset. Limitations of the study are sample size and inability at this time to test for longevity of retention. The study is ongoing and future directions plan to assess retention of the skills obtained through the curriculum as well as expand the sample size by implementing the curriculum at multiple points in the year and with each incoming resident class.

NYU Langone Hospital-Long Island
NYU Langone- Long Island Hospital

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