Above: Dr. Sandesh Shivananda, Assistant Professor in Neonatology
Can we provide better care for preterm babies?
Those behind the RESIN study, the largest project currently underway in the NICU, believe that yes, we can.
And they have the video to prove it.
“We have some preliminary data,” says Dr. Sandesh Shivananda of the study that he heads, “and it’s already showing that we are making significant inroads at 72 hours of life. We are seeing less sick babies, and because they are less sick we are able to start feeds for them earlier.” Not bad for a new project that has been running for just nine months and that is also the largest the neonatology division has seen in nearly two decades.
The primary focus of the project—titled “Resuscitation and Early Stabilization Improvement in Newborns (RESIN)”—is knowledge translation, bringing the professions together in order to provide optimal care in the “golden” hour, that crucial first hour of life in preterm babies. The RESIN study has been undertaken in recognition that for any child cared for in the Neonatal Intensive Care Unit (NICU), there is a staff made up of nearly 200 individuals — from physicians, to nurses, to nurse practitioners — all of whom need to be working in consort with one another. As you might imagine, that’s much easier said than done.
“Implementing care bundles is the only way to bring best practices to the bedside and to keep pace with all the progress that is being made in health care,” says Shivananda. “We are trying to introduce seven different practice changes, all implemented in the first hour of life, so that we increase the quality of care to give a good start for all the preterm infants.”
Some of those practice changes — such as, using a breathing device in place of a bag and mask to reduce injury to the lungs, reducing light and noise in the NICU to create a more comforting environment, and standardizing nutrition and stabilization guidelines —were easy, early on, for all the professionals within the NICU to support. Others were a bit of a harder sell, placing a video camera in the birthing suite being chief among them. The camera captures everything that happens in a child’s first hour of life: everything said, everything not said, everything done, and everything not done or not done as well as it could have been. The video is then used to debrief the team about what went well and to address any areas for improvement.
For Shivananda, this kind of group training and critique represents the “highest form of learning” within a team setting. It’s been implemented in NICUs in the United States and Australia, so some very positive models are described in the literature, although the application at McMaster represents the first of its kind in Canada.
Understandably, this method met with some initial resistance. “It took about six months to convince everybody,” says Shivananda, “[but] we introduced it gradually, first in a simulation lab setting where there was no patient.” Then the teams worked from there into the NICU and ultimately into an active patient care context. Now “people have seen the video...and they have understood how useful it is to see themselves, and [that it can] provide an opportunity to improve their performance,” says Shivananda.
So far it’s working. Thanks in no small part to an NICU team that has, across the board, provided support for what Shivananda and his team are trying to accomplish. “It is extremely important to get inter-professional groups to work together to achieve better patient outcomes in intensive care units,” says Shivananda. And since the RESIN study launched in August 2011, they have been.