Bio

Bio


Clinical Assistant Professor of Pediatrics; Division of Neonatal and Developmental Medicine.

Experienced Pediatrician/Neonatologist with training as a Stanford Biodesign Innovation Fellow interested in promoting medtech innovation in neonatology, pediatrics and women's health. Research interests also include: neonatal resuscitation, simulation, human factors, information data displays.

Faculty, Center for Advanced Pediatric and Perinatal Education (CAPE)
Stanford Assistant Director, UCSF-Stanford Pediatric Device Consortium
Instructor, Stanford Byer's Center for Biodesign Faculty Fellows Program
Co-Founder, Cadence Digital, Inc.

Clinical Focus


  • Neonatal-Perinatal Medicine

Professional Education


  • Board Certification: Neonatal-Perinatal Medicine, American Board of Pediatrics (2018)
  • Fellowship:Lucile Packard Children's Hospital at Stanford University Medical CenterCA
  • Board Certification: Pediatrics, American Board of Pediatrics (2013)
  • Residency:Lucile Packard Children's Hospital (2013) CA
  • Medical Education:State University of New York at Buffalo School of Medicine (2010) NY
  • MD, Lucile Packard Children's Hospital at Stanford University, Neonatal-Perinatal Medicine (2016)
  • MD, Lucile Packard Children's Hospital at Stanford University, Pediatrics Resident (2013)
  • MD, SUNY Buffalo School of Medicine and Biomedical Sciences, Medicine (2010)
  • BS, Brown University, Neuroscience (2003)

Research & Scholarship

Projects


  • Improving diagnostic accuracy and efficiency by optimization of bedside data display: A human factors approach, Stanford University

    Current methods of bedside data display in intensive care units requires healthcare professionals to assimilate multiple sources of data located in separate physical and virtual locations in order to respond to time sensitive changes in clinical status. Such a system fails to facilitate pattern recognition essential for the trainee learning experience; thus is suboptimal for both ensuring patient safety and enhancing skill acquisition. Other high-risk industries have developed strategies to address these safety and human performance issues. In the commercial aviation industry, flight cockpits are designed to facilitate expedient assimilation of time sensitive data (“the glass cockpit”) and their implementation has been shown to reduce crew mental workload, prevent accidents/errors and enhance cost savings. Such a strategy may yield similar results when applied in healthcare. The aim of this study is to evaluate if simultaneous data display (patient problem list, vital sign trends/current vital signs, pertinent laboratory results, and most recent radiographs) at the patient bedside improves diagnostic accuracy and efficiency in a simulated neonatal intensive care environment.

    Location

    Welch Road, Palo Alto, CA

    Collaborators

Publications

All Publications


  • Simulation-Based Patient-Specific Multidisciplinary Team Training in Preparation for the Resuscitation and Stabilization of Conjoined Twins AMERICAN JOURNAL OF PERINATOLOGY Yamada, N. K., Fuerch, J. H., Halamek, L. P. 2017; 34 (6): 621-626

    Abstract

    The resuscitation of conjoined twins is a rare and complex clinical challenge. We detail how patient-specific, in situ simulation can be used to prepare a large, multidisciplinary team of health care professionals (HCPs) to deliver safe, efficient, and effective care to such patients. In this case, in situ simulation allowed an 18-person team to address the clinical and ergonomic challenges anticipated for this neonatal resuscitation. The HCPs trained together as an intact team in the actual delivery room environment to probe for human and system weaknesses prior to this unique delivery, and optimized communication, teamwork, and other behavioral skills as they prepared for the simultaneous resuscitation of two patients who were physically joined to one another.

    View details for DOI 10.1055/s-0036-1593808

    View details for Web of Science ID 000400074500016

  • Simulation-Based Patient-Specific Multidisciplinary Team Training in Preparation for the Resuscitation and Stabilization of Conjoined Twins. American journal of perinatology Yamada, N. K., Fuerch, J. H., Halamek, L. P. 2016: -?

    Abstract

    The resuscitation of conjoined twins is a rare and complex clinical challenge. We detail how patient-specific, in situ simulation can be used to prepare a large, multidisciplinary team of health care professionals (HCPs) to deliver safe, efficient, and effective care to such patients. In this case, in situ simulation allowed an 18-person team to address the clinical and ergonomic challenges anticipated for this neonatal resuscitation. The HCPs trained together as an intact team in the actual delivery room environment to probe for human and system weaknesses prior to this unique delivery, and optimized communication, teamwork, and other behavioral skills as they prepared for the simultaneous resuscitation of two patients who were physically joined to one another.

    View details for PubMedID 27832667

  • Impact of Standardized Communication Techniques on Errors during Simulated Neonatal Resuscitation. American journal of perinatology Yamada, N. K., Fuerch, J. H., Halamek, L. P. 2016; 33 (4): 385-392

    Abstract

    Aim Current patterns of communication in high-risk clinical situations, such as resuscitation, are imprecise and prone to error. We hypothesized that the use of standardized communication techniques would decrease the errors committed by resuscitation teams during neonatal resuscitation. Methods In a prospective, single-blinded, matched pairs design with block randomization, 13 subjects performed as a lead resuscitator in two simulated complex neonatal resuscitations. Two nurses assisted each subject during the simulated resuscitation scenarios. In one scenario, the nurses used nonstandard communication; in the other, they used standardized communication techniques. The performance of the subjects was scored to determine errors committed (defined relative to the Neonatal Resuscitation Program algorithm), time to initiation of positive pressure ventilation (PPV), and time to initiation of chest compressions (CC). Results In scenarios in which subjects were exposed to standardized communication techniques, there was a trend toward decreased error rate, time to initiation of PPV, and time to initiation of CC. While not statistically significant, there was a 1.7-second improvement in time to initiation of PPV and a 7.9-second improvement in time to initiation of CC. Conclusions Should these improvements in human performance be replicated in the care of real newborn infants, they could improve patient outcomes and enhance patient safety.

    View details for DOI 10.1055/s-0035-1565997

    View details for PubMedID 26485251

  • Impact of a novel decision support tool on adherence to Neonatal Resuscitation Program algorithm RESUSCITATION Fuerch, J. H., Yamada, N. K., Coelho, P. R., Lee, H. C., Halamek, L. P. 2015; 88: 52-56

    Abstract

    Studies have shown that healthcare professionals (HCPs) display a 16-55% error rate in adherence to the Neonatal Resuscitation Program (NRP) algorithm. The aim of this study was to evaluate adherence to the Neonatal Resuscitation Program algorithm by subjects working from memory as compared to subjects using a decision support tool that provides auditory and visual prompts to guide implementation of the Neonatal Resuscitation Program algorithm during simulated neonatal resuscitation.Healthcare professionals (physicians, nurse practitioners, obstetrical/neonatal nurses) with a current NRP card were randomized to the control or intervention group and performed three simulated neonatal resuscitations. The scenarios were evaluated for the initiation and cessation of positive pressure ventilation (PPV) and chest compressions (CC), as well as the frequency of FiO2 adjustment. The Wilcoxon rank sum test was used to compare a score measuring the adherence of the control and intervention groups to the Neonatal Resuscitation Program algorithm.Sixty-five healthcare professionals were recruited and randomized to the control or intervention group. Positive pressure ventilation was performed correctly 55-80% of the time in the control group vs. 94-95% in the intervention group across all three scenarios (p<0.0001). Chest compressions were performed correctly 71-81% of the time in the control group vs. 82-93% in the intervention group in the two scenarios in which they were indicated (p<0.0001). FiO2 was addressed three times more frequently in the intervention group compared to the control group (p<0.001).Healthcare professionals using a decision support tool exhibit significantly fewer deviations from the Neonatal Resuscitation Program algorithm compared to those working from memory alone during simulated neonatal resuscitation.

    View details for DOI 10.1016/j.resuscitation.2014.12.016

    View details for Web of Science ID 000352508400023

    View details for PubMedID 25555358

  • The Neonatal Resuscitation Program: Current Recommendations and a Look at the Future INDIAN JOURNAL OF PEDIATRICS Kumar, P., Yamada, N. K., Fuerch, J. H., Halamek, L. P. 2014; 81 (5): 473-480

    Abstract

    The Neonatal Resuscitation Program (NRP) consists of an algorithm and curriculum to train healthcare professionals to facilitate newborn infants' transition to extrauterine life and to provide a standardized approach to the care of infants who require more invasive support and resuscitation. This review discusses the most recent update of the NRP algorithm and recommended guidelines for the care of newly born infants. Current challenges in training and assessment as well as the importance of ergonomics in the optimization of human performance are discussed. Finally, it is recommended that in order to ensure high-performing resuscitation teams, members should be selected and retained based on objective performance criteria and frequent participation in realistic simulated clinical scenarios.

    View details for DOI 10.1007/s12098-013-1332-0

    View details for Web of Science ID 000335739000011

    View details for PubMedID 24652267

  • A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Epstein, L. H., Roemmich, J. N., Robinson, J. L., Paluch, R. A., Winiewicz, D. D., Fuerch, J. H., Robinson, T. N. 2008; 162 (3): 239-245

    Abstract

    To assess the effects of reducing television viewing and computer use on children's body mass index (BMI) as a risk factor for the development of overweight in young children.Randomized controlled clinical trial.University children's hospital.Seventy children aged 4 to 7 years whose BMI was at or above the 75th BMI percentile for age and sex.Children were randomized to an intervention to reduce their television viewing and computer use by 50% vs a monitoring control group that did not reduce television viewing or computer use.Age- and sex-standardized BMI (zBMI), television viewing, energy intake, and physical activity were monitored every 6 months during 2 years.Children randomized to the intervention group showed greater reductions in targeted sedentary behavior (P < .001), zBMI (P < .05), and energy intake (P < .05) compared with the monitoring control group. Socioeconomic status moderated zBMI change (P = .01), with the experimental intervention working better among families of low socioeconomic status. Changes in targeted sedentary behavior mediated changes in zBMI (P < .05). The change in television viewing was related to the change in energy intake (P < .001) but not to the change in physical activity (P =.37).Reducing television viewing and computer use may have an important role in preventing obesity and in lowering BMI in young children, and these changes may be related more to changes in energy intake than to changes in physical activity.

    View details for Web of Science ID 000253672100007

    View details for PubMedID 18316661

    View details for PubMedCentralID PMC2291289