Tablet-based documentation during neonatal resuscitation

Summary In neonatal resuscitation, accuracy of documentation is crucial for clinical and medico-legal reasons, and for quality improvement. This prospective cohort study will compare a tablet App-based documentation with the conventional paper-based documentation.

Project Details

About 7% of newborn infants require interventions at birth to support their transition to the extrauterine environment. Supporting the newly born infant’s breathing is the most common intervention. If there is no response, more advanced interventions (chest compressions, vascular access to administer fluids and drugs) may be required. These interventions should be performed at specific time intervals and in a stepwise manner. Human factors such as situational awareness may affect the quality of care provided and having a dedicated team member to scribe events is important. Accurate documentation is essential not only to help the team keep track of the interventions, but also for quality improvement and is medico-legally responsible.  Although electronic records have replaced handwritten documentation in many care pathways, documentation during emergency situations, such as neonatal resuscitation, has been and remains paper-based. These handwritten notes are often recorded retrospectively, and not formally protocolised. This may lead to inaccuracy and bias in the recorded data. Real-time documentation by an independent scribe not involved in the resuscitation is more accurate but continues to be a challenge, especially in emergent and unanticipated resuscitations.

Studies in simulated adult emergency scenarios showed an improvement in documentation quality with the use of tablet computer-based applications ( i.e. improvement in precision of intervention time documentation by 78% compared to standard system), together with high levels of satisfaction among users and without compromising clinical performance. Potential disadvantages of electronic records are mainly related to the need to learn how to use a new system and performing a potentially cumbersome process during a critical situation. As far as we know, there are no published studies assessing the efficacy and performance of tablet- or smartphone-based applications for documentation during neonatal resuscitation.

In this prospective observational cohort study we will assess the efficacy of a Smartphone App-based documentation record, compared to the standard paper-based documentation, in 50 neonatal resuscitation scenarios. Comparative effectiveness will be ascertained by comparing documentations (paper and electronic) with real time video recording from the neonatal resuscitation. We will also describe the agreement of resuscitation interventions with resuscitation guidelines, and determine types of documentation errors: omission, timing, commission, sequencing and registration.