Project Summary
In the U.S., approximately 400,000 newborns require resuscitation every year. The decisions made
and interventions performed in those first minutes of life can determine whether the child lives, dies or
survives with significant lifelong morbidity. Neonatal resuscitation is a time-pressured activity requiring
teams to coordinate invasive procedures in a specific sequence of steps. Because error rates in excess
of 50% during neonatal resuscitation have been reported, enhancing the effectiveness and safety of
those interventions will have a profound impact on the number of lives saved, the quality of life for
survivors, and the annual cost of neonatal intensive care (which currently surpasses $25B). This work
will focus on improving three specific aspects of neonatal resuscitation: the design of the physical
workspace, decision making during this invasive procedure, and human-technology interaction.
We will assess the range of neonatal resuscitation environments currently in use and, via simulation
and iterative design, explore different room configurations to determine the layouts that facilitate
enhanced team performance. We will investigate how to display key anatomic and physiologic data,
detect data that is trending negatively, and alert staff before an actual threat becomes manifest. We will
also experiment with methods of minimizing patient handling and reducing the need for manual
adjustments of devices that produce imprecise results and interfere with patient care procedures. To
accomplish these aims this proposal brings together experts in clinical neonatology, resuscitation,
engineering, human factors, human-centered design and healthcare simulation.
This project is significant in several ways. First, by taking a systems engineering approach to neonatal
resuscitation, examining how individual subsystems (patients, healthcare professionals, physical
environments, equipment, supplies, interventions, data, regulations, culture) impact the overall system,
we will develop a comprehensive model that identifies multiple potential points of intervention for
improving patient care. Second, because even the most uncomplicated delivery occurring in a low-acuity,
low-volume hospital or birth center can evolve within minutes to become a life-threatening emergency for
the newborn, the benefits of this work will be generalizable to every facility where pregnant women give
birth – rural, inner city, urban and suburban. Third, this study focuses on neonates, including those born
to Black, Latino, Indigenous and Native American, Asian American, Pacific Islander and LGBTQ+
women, all of whom represent AHRQ priority populations. Finally, the results of this work will extend well
beyond the neonatal population, as they will be applicable to improving human and system performance
in other complex, safety-critical, time-pressured healthcare domains involving the surgical, emergency
and intensive care of pediatric, obstetric and adult patients.
