Learning Objective #1: describe how clarity of a role and confidence in that role impacts patient outcomes.

Learning Objective #2: describe two training methods to maintain staff competency in a high risk low volume hospital environment.

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Effective teamwork, developed by standardizing roles and procedures, has been tied to improved patient outcomes in healthcare. There are challenges to building a strong team in a low volume community hospital. The ValleyCare Medical Center in Pleasanton California utilizes a multidisciplinary team of physicians, registered nurses, and respiratory care practitioners to respond to high-risk deliveries. Our initial process improvement evaluation found there was no consistency in response and no sense of teamwork particularly between the respiratory therapists and the registered nurses. The Golden Hour Resuscitation program was utilized to train the multidisciplinary team. A baseline questionnaire was used to measure role knowledge and comfort in the role. Participants were asked to assess their understanding of and confidence in their role, and to rate overall communication between the team members. They also evaluated whether or not the teamwork was effective in an emergent situation. Training, including mock resuscitation codes, was then conducted with all team members. Questionnaires were repeated after training, and reflected increased understanding and comfort in each person's role. All felt communication between team members was also improved. Training alone does not suffice especially in a small hospital where high-risk deliveries are not routine. We ask all team members to complete questionnaires after every resuscitation. Scores have improved in all areas and retrospective critiques of the codes show improvement in timeliness of interventions. In addition to reviewing all neonatal resuscitations we are conducting ongoing mock drills with the entire multidisciplinary team utilizing a high fidelity simulation baby mannequin. These are timed and critiqued for appropriate resuscitative measures and equipment use. Team members will continue to be involved in the assessment, both as observers and through feedback on their role.