Oral Themed Presentation
Background: : Neonatal resuscitation takes place in approximately 10% of the 4 million births in the United States annually. While the infant bed is central to all neonatal resuscitation efforts, its height or position is not easily adjustable and thus not quickly adaptable to the broad anthropometric variation of the healthcare professionals (HCPs) responsible for the emergent procedures that occur during neonatal resuscitation. When performing two of the most common invasive interventions during neonatal resuscitation (i.e. intubation and chest compressions), HCPs bend down, lean over the center of the bed, and rotate their torsos in order to successfully execute these procedures. These non-neutral postures are potential risk factors for injury, unsuccessful or inappropriate procedure performance, and ultimately, patient harm.
Research Question: : How does the positioning of the infant bed influence the working posture and spinal loading in HCPs when performing intubation and chest compressions during neonatal resuscitation?
Hypothesis: Design of infant bed, specifically the height of the bed, impacts the risk of low back injury.
Methodology: : Fifteen subjects were recruited from the nursing and physician staff at a Level IV neonatal intensive care unit to participate in a simulation-based study of neonatal resuscitation procedures. All subjects performed intubation and chest compressions on a newborn manikin using the same medical equipment that is used in clinical practice. All procedures were videotaped using a camera positioned in an orthogonal position for subsequent biomechanical analyses. In a randomized complete block design, subjects completed two trials per task: one with the manikin at a preset height (100cm) of the neonatal bed and one at a self-selected bed height of each subject’s preference. Anthropometric, grip and pinch strength data were collected during the trials.
This study was approved by the Stanford University IRB.
Results: : Data analysis is underway and will be completed prior to the IPSSW in May 2019. In order to conduct the biomechanical analysis, joint angles measured on still images taken from the video recording of each trial will be extracted. These angles along with the strength data collected will serve as input for the biomechanical analysis. Compressive and shear forces will be computed using the 3D Static Strength Prediction Program™ from University of Michigan. The results of the biomechanical analysis will be interpreted in the context of clinical outcome measures, including time to completion of intubation and duration of correct technique for chest compressions. ANOVA will be performed to determine statistical significance for the clinical performance and biomechanical results of each task at the two different bed heights.
Discussion/Conclusions: : The design of current medical equipment is largely industry-driven with little input from end users. In the context of time-pressured and emergency care such as resuscitation, the needs of the HCPs responsible for performing life-saving procedures are particularly important in order to facilitate the provision of safe and efficient patient care. This study is among the first to examine the needs and challenges faced by neonatal HCPs as presented by their working environment. This study also demonstrates the use of simulation-based research as a methodology to investigate system weaknesses and examine human factors-based solutions.