Streamlining Neonatal Care: A Real-World Success Story

In the high-pressure world of neonatal care, a single decision can change a life. Every intervention requires rapid response, precise procedures, and seamless coordination across an entire team. The neonatal intensive care team of the Leiden University Medical Center (LUMC) harnessed the power of video review, transforming the way they approach their life-saving work.

The journey: from recording to refining

The Leiden University Medical Center (LUMC) is a tertiary university-affiliated hospital, containing a 25-bed NICU, annually admitting 500-600 neonates.

• Revealing insights through video recording: in 2009, the NICU of the LUMC implemented recording of neonatal stabilization for research purposes. Recordings captured the hands of the caregivers, the infant and the physiological parameters. It led to many discoveries about physiology, but also guideline compliance, showing that caregivers frequently diverged from guidelines and documentation was often insufficient. The medical team found that the process quickly became natural, fading seamlessly into the background of their critical work.

• The power of team conference: weekly video review of neonatal stabilization was implemented in 2014 by the NICU of the LUMC, with mostly medical staff attending. Video review didn't replace debriefings; it supercharged them. The team discussed the footage together, pinpointing strengths, identifying improvement areas, and developing better strategies based on the shared experience. Video review resulted in improved guideline compliance and documentation.

• Expanding video review: since 2021, video review was expanded to other neonatal procedures, such as endotracheal intubation and sterile procedures. The focus of video review was on including both medical and nursing staff. In addition, audio was recorded, to enable evaluation of teamwork and communication. This expanded way of video review was not only accepted by providers, but also appreciated. Video review resulted in a continuous learning and improvement process on the NICU and was used in various ways to improve care.

Tangible Results, Stronger Teams

The impact of this approach went beyond theory:

• Improving care: It streamlined their workflow, unearthed unexpected solutions, and strengthened their commitment to collaboratively deliver the absolute best care.

• Smoother Processes: simple changes in equipment setup or guidelines, revealed by the video footage, decreased preparation time for recurring procedures.

• Confidence and Collaboration: Staff at all levels reported to see the added value of video review. During Neoflix, a save learning environment was created, fostering collaboration and reducing the reliance on top-down instruction.

The Promise of Video Review

For this neonatal team, video review wasn't just a task; it's become a powerful tool. This case study is proof – in the relentless pursuit of excellence, video review offers a transformative advantage. The results of over 20 years of experience in video review has resulted in the design of the Neoflix toolbox.

Literature:

den Boer MC, Houtlosser M, Foglia EE, Tan R, Engberts DP, Te Pas AB. Benefits of recording and reviewing neonatal resuscitation: the providers' perspective. Arch Dis Child Fetal Neonatal Ed. 2019;104(5):F528-f34.

Root L, van Zanten HA, den Boer MC, Foglia EE, Witlox R, Te Pas AB. Improving Guideline Compliance and Documentation Through Auditing Neonatal Resuscitation. Front Pediatr. 2019;7:294.

Schilleman K, Siew ML, Lopriore E, Morley CJ, Walther FJ, Te Pas AB. Auditing resuscitation of preterm infants at birth by recording video and physiological parameters. Resuscitation. 2012;83(9):1135-9.

Schilleman K, Witlox RS, van Vonderen JJ, Roegholt E, Walther FJ, te Pas AB. Auditing documentation on delivery room management using video and physiological recordings. Arch Dis Child Fetal Neonatal Ed. 2014;99(6):F485-90.

van Vonderen JJ, van Zanten HA, Schilleman K, Hooper SB, Kitchen MJ, Witlox RS, et al. Cardiorespiratory Monitoring during Neonatal Resuscitation for Direct Feedback and Audit. Front Pediatr. 2016;4:38.

Heesters, V., Witlox, R., van Zanten, H. A., Jansen, S. J., Visser, R., Heijstek, V., & Te Pas, A. B. (2022). Video recording emergency care and video-reflection to improve patient care; a narrative review and case-study of a neonatal intensive care unit. Frontiers in Pediatrics, 10, 931055.

Heesters, V., Dekker, J., Panneflek, T. J., Kuypers, K. L., Hooper, S. B., Visser, R., & te Pas, A. B. (2024). The vocal cords are predominantly closed in preterm infants< 30 weeks gestation during transition after birth; an observational study. Resuscitation, 194, 110053.

Heesters, V., van Zanten, H. A., den Boer, M. C., Te Pas, A. B., & Witlox, R. S. (2024). Using the providers’ perspective on video review of neonatal procedures to create a roadmap: a qualitative study. Archives of Disease in Childhood-Fetal and Neonatal Edition.

Heesters, V., van Zanten, H. A., Heijstek, V., Te Pas, A. B., & Witlox, R. S. (2024). Record, reflect and refine: using video review as an initiative to improve neonatal care. Pediatric Research, 1-10.