Current Research and Scholarly Interests
My particular area of research interest lies in using simulation methodology to understand the cognitive, technical and behavioral skills needed during neonatal resuscitation. First, I wanted to understand how accurate human senses are in the detection of neonatal heart rate during simulated resuscitation. As providers of neonatal resuscitation we are taught an algorithm that presumes we are able to precisely detect a newborn’s heart rate and, based on that value, respond appropriately according to set guidelines. But what if the accuracy of the current standard is deficient and providers either fail to perform appropriate interventions or perform inappropriate interventions? Using simulation based methodology I was the principle investigator in a prospective, randomized controlled trial investigating how accurate certified providers of neonatal resuscitation are at determining heart rate when faced with various resuscitation scenarios. I found that providers were inaccurate in their heart rate determination ~40% of the time using either auscultation of the chest or palpation of umbilical pulsations. It is time to study other means of heart rate determination in the delivery room (oximetry, ECG leads) because the accuracy of the current standard is deficient and results in errors of omission (lack of appropriate interventions) and commission (inappropriate interventions). This work was published in the journal Resuscitation.
Next, I wanted to investigate a way to optimize the organization of equipment and supplies required when responding to neonatal resuscitations in our hospital. There have been several emergent resuscitations I have responded to during my fellowship where I was frustrated at the lack of appropriate equipment at my disposal and/or the delay in obtaining such equipment. At Lucile Packard Children’s Hospital (LPCH) supplies for certain resuscitations must be obtained from up to four different places, taking on average 6-8 minutes. After surveying medical directors in NICUs across the United States I found that, although 75% of NICUs have all of their supplies located in one area, it takes an average of 5 minutes (range 1-30 minutes) to gather this equipment. Such preparation times are too long to allow for an efficient, timely resuscitation. I believed that creation of a resuscitation cart specifically designed for neonates of various sizes and with differing disease states could greatly improve our ability to respond to and appropriately care for these newborns. As such, my co-fellow and I designed a neonatal resuscitation cart (NRC) based on the ABC’s (airway, breathing, circulation) of resuscitation. Using simulation-based methodology, we performed a prospective, randomized, controlled, crossover trial design to compare the utility of a NRC with the current standard at LPCH. We found that use of a supply cart designed specifically for use during neonatal resuscitation (NRC) allowed healthcare professionals to more quickly acquire equipment and supplies and institute indicated resuscitation procedures when compared to our current standard. We believe that this is likely to result in improved human performance during actual neonatal resuscitations and potentially better patient outcomes. I was the principle investigator on this project and our work has been published in BMJ Quality and Safety. The NRCs are now in use in our delivery rooms and NICUs at LPCH.