An observational study using video recordings to explore the first hour
after admission to a Neonatal Intensive Care Unit (NICU)
Abstract
AIM To explore the admission process to our Neonatal Intensive Care
Unit. METHODS A first phase quality improvement initiative was
conducted. We utilised observational video recording of a convenience
sample of inborn admissions. Two remote GoPro cameras were placed, one
giving an overview of activity and the other focussed on the infant.
Recordings captured the first hour after admission including transfer to
the NICU by the birthing team. The video footage of each case study was
reviewed by a multidisciplinary panel using an agreed semi quantitative
analysis of events. RESULTS Ten admissions to the NICU were video
recorded between June and October 2018. Gestational age 282- 401. A
focus on maintaining airway support was inconsistent as was the ability
to provide continuous monitoring of vital signs. Overall leadership of
the process was lacking, and handover often appeared fragmented. Median
temperature on admission was 362 (354-373) oC. Vascular access and fluid
management occurred at a median of 36 (13 – 67) minutes. CONCLUSIONS
Planning and approval for this study was protracted, particularly
negotiating the use of video recording. Anecdotally, this delay is
thought to have contributed to an improvement in managing admissions,
particularly when maintaining airway support and monitoring. However,
our baseline data has highlighted a lack of leadership, fragmented
handover, low admission temperatures and broad time frames to achieve
vascular access. A guideline to streamline handover and nursery
transition is currently being implemented, a subsequent evaluation cycle
is planned.