RESUMEN
Background: Preterm infants born at <32 weeks gestational age (GA) have increased morbidity if they are born outside tertiary centres (outborn). Stabilization and resuscitation after birth consistent with the neonatal Golden Hour practices (NGHP) are required to optimize outcomes. Objectives: To evaluate physiological outcomes of hypothermia and hypoglycaemia, and compliance with NGHP by neonatal transport team (NTT) compared with referral hospital team (RHT) during the stabilization of infants born at <32 weeks GA. Methods: A retrospective case-control study of infants born at <32 weeks GA during 2016-2019 at non-tertiary perinatal centres where the NTT attended the delivery (cases) were matched to infants where the RHT team attended the delivery (controls). Results: During the 4-year period, NTT team received 437 requests to attend deliveries at <32 weeks GA and attended 76 (17%) prior to delivery. These cases were matched 1:1 with controls composed of deliveries attended by the RHT. The rate of hypothermia was 15% versus 29% in the NTT and RHT groups, respectively (P = 0.01). The rate of hypoglycaemia (<2.2 mmol/L) was 5% versus 12% in the NTT and RHT groups, respectively (P = 0.64). For compliance with the NGHP, use of fluid boluses was 8% versus 33%, use of thermoregulation practices, that is, plastic bag, was 76% versus 21%, and establishment of intravenous access was 20 min versus 47 min, in the NTT and RHT groups, respectively. Conclusions: High-risk preterm deliveries attended by the NTT compared with the RHT had increased compliance and earlier implementation of the NGHP elements, associated with improved physiological stability and lower hypothermia rates. Outreach education for RHT should ensure that these key elements are included during the training in the stabilization of high-risk preterm deliveries.
RESUMEN
OBJECTIVE: We aimed to determine if the implementation of Situation, Background, Assessment, Recommendation (SBAR) training improved the quality of real-life telephone communication. We evaluated interfacility neonatal and pediatric transports performed by registered nurses, respiratory therapists, and physicians (MDs). METHODS: This was a quality improvement study performed to evaluate telephone communication before and after SBAR training. Training consisted of lectures, review of audio files, and simulated role-playing. Recorded audio files of real-life transports were evaluated for clarity and content by 3 raters using a standardized scoring tool. RESULTS: Ninety-four and ninety-three calls were evaluated before and after the intervention, respectively. The total item scores were higher posttraining (mean ± standard deviation [pre: 15.06 ± 2.60, post: 17.60 ± 2.61], P < .001). Global rating scores ≥ 4 were higher in the posttraining group (pre: 50.0% vs. post: 66.7%; P = .02; odds ratio = 1.43; 95% confidence interval, 1.04-1.97). There was no significant difference in the duration of calls (mean ± SD [pre: 9.29 ± 4.59 minutes, post: 9.70 ± 4.65 minutes). In subgroup analysis, the total item score was significantly improved posttraining for registered nurses and respiratory therapists but not MDs. CONCLUSION: Standardized SBAR training was effective in improving telephone communication by RNs and RTs. The inclusion of SBAR training routinely within the educational curriculum of transport programs can enhance communication.