Who is performing medical procedures in the neonatal intensive care unit?

Abstract

Objective: Owing to resident work-hour reductions and more permanent personnel in the newborn intensive care unit (NICU), we sought to determine if pediatric housestaff are missing learning opportunities in procedural training due to non-participation.Study Design: A prospective, observational study was conducted at an academic NICU using self-reported data from neonatal personnel after attempting 188 procedures on 109 neonates, and analyzed using Fisher's exact and w 2 -tests.Result: Housestaff first attempted 32% of procedures (P<0.001) and were less likely to make attempts early in the academic year (P<0.001).There was no significant difference in attempts based on urgency of situation (P ¼ 0.742). Of procedures performed by non-housestaff personnel, 93% were completed while housestaff were present elsewhere in the unit. Conclusion:Pediatric housestaff performed the minority of procedures in the NICU, even in non-urgent situations, and were often uninvolved in other procedures, representing missed learning opportunities.

Effect of Procedure Simulation Workshops on Resident Procedural Confidence and Competence

“…30 neonatal intubations throughout residency training in 1994-1996 and that number had declined to , 20 in 1999-2002. Gozzo et al, 8 examining whether residents missed procedural opportunities because of nonparticipation, found a significantly smaller percentage of procedures attempted by residents (32%) compared with nonresident practitioners. Decreasing procedural opportunities have been attributed to duty hour restrictions, limited intensive care rotations, and the presence of increasing numbers of other clinical personnel, such as nurse practitioners, physician assistants, fellows, and attending hospitalists.…”

“…Residents' lack of procedural competence may, in part, be a reflection of limited clinical opportunities to perform procedures 6,8 and/or inadequate alternative procedural education. A 2007 article 4 noted that only 40% to 70% of pediatrics residency programs have a formal method for teaching arterial puncture, bladder catheterization, peripheral IV placement, lumbar puncture, and venipuncture.…”

Improving neonatal intubation safety: A journey of a thousand miles

“…Pediatric residents' suboptimal success rates likely stem from the limited experience with neonatal intubation. Gozzo et al observed that pediatric residents performed few procedures in the NICU [9]. In a 2015 study of pediatric resident neonatal intubation competency, DeMeo et al cited a median number of 3 intubation opportunities per resident during training [10].…”

“…In a 2015 study of pediatric resident neonatal intubation competency, DeMeo et al cited a median number of 3 intubation opportunities per resident during training [10]. The limited clinical experience is multifactorial, resulting from restrictions in duty hours and NICU rotations [11], increased presence of advanced practice providers in the NICU [9,12], changes in management of infants with meconium-stained amniotic fluid [13], and increasing usage of non-invasive ventilation strategies [14]. As opposed to residents, neonatal fellows report considerably more neonatal intubation experiences, with an average of 60 intubations by graduation [15].…”

Achieving Procedural Competency during Neonatal Fellowship Training: Can Trainees Teach Us How to Teach?

“…In fact, other studies have used the starting point of describing current processes for intubation and their overall success, including provider, patient, and procedural characteristics, concluding that success can fluctuate widely [15]. Due to this finding, some potential solutions suggested for advancing procedural education include specific critical care tracks to increase procedural exposure, the use of smartphone technology, optimizing procedural exposure of house staff, and simulation, including “just in time” training and deliberate practice, especially in light of overall decreasing attendance at deliveries during training periods [2, 15-18]. These approaches would likely compliment the “5 Ps” and provide meaningful input from both the trainer and the trainee.…”