Aim The aim of this study was to assess the resuscitators' opinions of the usefulness and clinical value of using a respiratory function monitor (RFM) when resuscitating extremely preterm infants with positive pressure ventilation. Methods The link to an online survey was sent to 106 resuscitators from six countries who were involved in a multicentre trial that compared the percentage of inflations within a predefined target range with and without the RFM. The resuscitators were asked to assess the usefulness and clinical value of the RFM. The survey was online for 4 months after the trial ended in May 2019. Results The survey was completed by 74 (70%) resuscitators of which 99% considered the RFM to be helpful during neonatal resuscitation and 92% indicated that it influenced their decision‐making. The majority (76%) indicated that using the RFM improved their practice and made resuscitation more effective, even when the RFM was not available. Inadequate training was the key issue that limited the effectiveness of the RFM: 45% felt insufficiently trained, and 78% felt more training in using and interpreting the RFM would have been beneficial. Conclusion Resuscitators considered the RFM to be helpful to guide neonatal resuscitation, but sufficient training was required to achieve the maximum benefit.

As the complexity of emergency care increases, current research methods to improve care are often unable to capture all aspects of everyday clinical practice. Video recordings can visualize clinical care in an objective way. They can be used as a tool to assess care and to reflect on care with the caregivers themselves. Although the use of video recordings to reflect on medical interventions (video-reflection) has increased over the years, it is still not used on a regular basis. However, video-reflection proved to be of educational value and can improve teams’ management and performance. It has a positive effect on guideline adherence, documentation, clinical care and teamwork. Recordings can also be used for video-reflexivity. Here, caregivers review recordings together to reflect on their everyday practice from new perspectives with regard to context and conduct in general. Although video-reflection in emergency care has proven to be valuable, certain preconditions have to be met and obstacles need to be overcome. These include gaining trust of the caregivers, having a proper consent-procedure, maintaining confidentiality and adequate use of technical equipment. To implement the lessons learned from video-reflection in a sustainable way and to continuously improve care, it should be integrated in regular simulation training or education. This narrative review will describe the development of video recording in emergency care and how video-reflection can improve patient care and safety in new ways. On our own department, the NICU at the LUMC, video-reflection has already been implemented and we want to further expand this. We will describe the use of video-reflection in our own unit. Based on the results of this narrative review we will propose options for future research to increase the value of video-reflection.

Purpose: The environment of the NICU can be dynamic and emergent. Video-reflection of neonatal interventions gives an objective view on clinical practice. Although video-reflection is increasingly used, it is focused mostly on technical aspects. The focus of video-reflection can also be shifted towards teamwork and context. However, no studies have explained the set-up for video-reflexive sessions of neonatal interventions and how to use it to drive change and improvement neonatal interventions. We aim to identify success factors and prerequisites for implementation of video-reflexivity and to create a manual for other departments. Methods: video-reflexive sessions will be conducted at the NICU of the LUMC. Interventions that are recorded include 1) line insertions, 2) intubations and MIST procedures and 3) neonatal resuscitations at birth. Caregivers can choose to record interventions they perform, are offered the option of reviewing the recordings and are invited to attend the multidisciplinary reflexive sessions. Observations regarding insights, ideas and discussions will be evaluated. Action-research will be performed to make improvements in neonatal care based. Results and conclusion: Institutional research ethics approval has been acquired. Results will be published in peer-reviewed journals and presented at relevant conferences. Findings will be presented to caregivers to inform them of ongoing improvements of neonatal interventions. Time is limited in an acute care department, not all caregivers can attend each session. We distribute findings from the reflexive sessions among all caregivers. Our proposal is based on the experience of a single center level III NICU.