Using Simulated Transport Calls to Identify Diversity of Knowledge and Care Plans among the Multidisciplinary Team

Abstract

Research has shown that patient safety and quality of care provided is affected by the knowledge, technical ability, and behavioral skills of each member of the multidisciplinary care team. All NICU patients at Boston Children's Hospital (BCH) are born at outside facilities. Thus, transport call preparedness is fundamental to providing exceptional care for NICU patients. Our study aims to answer the question: Does significant variance exist among the multidisciplinary team members in the interpretation of transport call data and the subsequent preparation that occurs when caring for critically ill neonates? The 2011 NICU Crisis Resource Management (CRM) course reflects results from a multidisciplinary needs assessment. Three transport calls for neonate with persistent pulmonary hypertension of the newborn (PPHN) were received by a multidisciplinary team. Each member completed a survey following each call. After the final transport call, the patient arrived in the simulator suite and the course progressed. One hundred forty interdisciplinary participants completed the course. After listening to the transport calls, 85.5% of participants categorized the patient as category, RED (Emergent/Urgent resuscitation-high acute status), while 14.5% of participants selected category, YELLOW (Patient in clinical transition or requiring time sensitive procedures). Of the healthcare providers, the highest percentage group selecting category YELLOW was the fellow group (18%), while 0% of the NNP group selected YELLOW. Blood pressure mean goal recommendations were more varied among the groups. Eighty-five per cent of attendings, 75% of neonatal nurse practitioners (NNPs), 75% of fellows, and 55% of RNs selected 40-50 mmHg; while 15% of attendings, 25% of NNPs, 12.5% of fellows, and 33% of RNs selected 50 mmHg or more. Importantly, 100% of participants, including attendings, NNPs, respiratory therapists (RTs), fellows, and RNs, said they would have a team "huddle" prior to the arrival of this infant. Within the variance that exists in regard to knowledge, experience, and practice among the multidisciplinary groups, attendings and NNPs tended to be more aligned with their assessment and approach. Simulated transport calls provide a safe environment to uncover these differences and to allow for future study to improve teamwork and to provide the best care for the critically ill neonate.