Potential Structural Obstacles to Effective Implementation of Neonatal Intensive Care Unit Rapid Response Teams

Background: In-hospital rapid response teams are critical to the prompt management of neonatal emergencies occurring in hospital delivery rooms. However, structural obstacles that exist within health care facilities may hinder the successful implementation of these teams. This study examined the prevalence of structural obstacles potentially impeding neonatal rapid response team movements between neonatal intensive care units and delivery rooms in hospitals with pediatric residency programs across the United States. Methods: One resident from each participating pediatric residency program was sent an anonymous online questionnaire to record the total number of steps needed to walk the most direct route between the neonatal intensive care unit and delivery room of their health care facility. Residents also recorded the number of doors and elevators located along this route as well as the minimum amount of time required to open them. In a follow-up survey, residents reported whether elevator or security door overrides existed in the event of an emergency. Results: One pediatric resident from each of 52 residency programs completed the questionnaire. On average, residents took 93 steps to get from the neonatal intensive care unit to the delivery room. At 30 hospitals (58%), the neonatal intensive care unit and delivery room were on different floors, requiring residents to use stairs or elevators. Of the 18 residents who responded to the follow-up survey, 14 (78%) reported either that there were no measures in place to expedite elevator or door travel or that they were not aware of any such measures. Between 30 and 60 seconds were spent opening doors or waiting for doors to open at six hospitals (12%). Conclusion: Structural obstacles in health care facilities may prevent units from being on the same floor, heightening the risk of injury for medical staff responding to neonatal emergencies, and increasing delays. Health care facility designs should take into consideration the impact of these obstacles in order to save valuable time and improve newborn outcomes.