AUTHOR=Zehnder Emily C. , Law Brenda H. Y. , Schmölzer Georg M. 

TITLE=Assessment of Healthcare Provider Workload in Neonatal Resuscitation

JOURNAL=Frontiers in Pediatrics

VOLUME=Volume 8 - 2020

YEAR=2020

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2020.598475

DOI=10.3389/fped.2020.598475

ISSN=2296-2360

ABSTRACT=Objective: Human errors or protocol deviations during neonatal resuscitation are common. Excess workload has been proposed as a contributor to human error during medical tasks. We aim to characterize healthcare providers’ perceived workload during neonatal resuscitation. 
Design: Perceived workload was measured using a multi-dimensional retrospective National Aeronautics and Space Administration Task Load Index (NASA TLX) survey. The NASA TLX collects data on mental, physical, and temporal demand, performance, effort, and frustration. Each section is rated independently by participants on a scale of 0-20 (0 being lowest and 20 being highest). The Raw-TLX score is a composite score of all dimensions and presented on a scale of 0-100. Healthcare providers complete a paper and pencil survey after attending delivery room resuscitations within three months.  
Measurement: Raw TLX scores as a measure of overall workload and scores for each dimension of workload.
Main Results: During the study period, ~880 neonatal resuscitation events occurred and a total of 204 surveys were completed; Healthcare providers completed 1 survey for 179 deliveries, 2 surveys for 20 deliveries, and 3 surveys for 5 deliveries. The mean (standard deviation) gestational age was 35 (5)  weeks and the median (interquartile range) birth weight was 2690 (1830-3440)g. Interventions at delivery were i) stimulation 149(73%), suction 130(64%), continuous positive airway pressure 120(59%), positive pressure ventilation 105(52%), intubation 33(16%), chest compression 10(5%), and epinephrine 4(2%).  The overall median (interquartile range) Raw-TLX was 34(18-49). The scores varied by dimension with mental demand 10(5-14), physical demand 4(1-6), temporal demand 8(3-14), performance 4(2-6), effort 8(4-13), and frustration 4(1-10). Raw-TLX scores were higher when healthcare providers performed any intervention compared to no intervention (35(22-49) versus 8(6-18), p=0.0011), intubation and no intubation was (55(46-62) versus 30(17-46), p=0.0001), and between performing chest compression versus no chest compression (55(49-64) versus 33(18-47), p=0.001).
Conclusion: Perceived workload of neonatal healthcare providers increases during higher acuity deliveries. Healthcare providers' workload during neonatal resuscitation can be measured using NASATLX and was inversely associated with 5- minute Apgar. Future studies assessing healthcare providers' perceived workload during neonatal resuscitation in different settings are warranted.