Optimizing time to treatment for Hypoxic Ischemic Encephalopathy (HIE) for Transported Neonates

Background: Most infants requiring therapeutic hypothermia (TH) therapy for Hypoxic Ischemic Encephalopathy (HIE) are born at facilities without therapeutic capabilities. There is a narrow timeframe for initiating TH, necessitating prompt identification, transport, and initiation of therapy. Qualifier documentation for therapy and neurologic exam is necessary for treatment initiation. Studies show documentation of resuscitations and neurologic exams are lacking. Transport teams must gather available documentation and ensure the accuracy of any qualifying or disqualifying neurologic exam to determine if treatment is indicated. Methods: The principal investigator performed a needs assessment survey to identify educational needs along with a 2-year chart review to uncover documentation gaps. An educational module was developed based on the results of the needs assessment for transport team members. A charting documentation form was created by key stakeholders based on charting gaps identified in the chart review process. The principal investigator created an updated guideline and flowchart algorithm to guide critical decisions during transport. Simulations were designed and performed to improve efficiency, hone neurologic assessment skills, utilize the new documentation form, and use the algorithm and guideline tools for decision making. Finally, a post-intervention survey and chart review was performed to determine education and documentation effectiveness. Results: Post-intervention, 100% (n=6) of team members had participated in pre/post-intervention surveys and the simulation lab. Respondents reported that 100% (n=6) found the education and simulations to have been "very" effective. Charting template satisfaction was reported as significantly improved (p = <0.00005) by participants. The post-intervention chart review detected significant improvements (p = 0.007) in three out of four documentation categories evaluated. Conclusions: Rare events simulation improved the confidence of participants during the interpretation of neurologic exams. By increasing awareness of documentation gaps and creating a document for use during HIE transports, improvements in documentation, identification, and therapy initiation, can be achieved, resulting in decreased missed opportunities for therapeutic hypothermia, and improved outcomes of infants suffering from HIE.