13.1 The Neoflix approach

NICU LUMC

Based on video review, the Neoflix team in the LUMC's NICU identified three core components that contributed to improving neonatal procedures:

• (i) Enhancing appropriate application of external evidence: Correctly applying guidelines and using equipment.

• (ii) Learning from individual clinical expertise: Adapting procedures in the 'gray zone' where guidelines don't cover all situations, ensuring the best approach based on individual patient, context, and setting.

• (iii) Strengthening teamwork and resilience of the NICU team: Ability to cope with complexity and adapt to changing conditions.

The following actions or interventions were defined for the Neoflix project:

1. Guideline/Equipment Adjustments: If guidelines or equipment are used incorrectly, either healthcare providers are educated or the guideline/equipment is adjusted.

2. Input for research: If a knowledge gap is identified, research is initiated (literature search or consultation with an expert/researcher). Gained knowledge is shared with the team.

3. Learning from variety / best Practices: Healthcare providers learn from successful variations in practice where guidelines fall short, improving their performance to suit specific patients and contexts.

4. Teamwork/Resilience Training: If teamwork or communication skills need improvement, training programs or educational materials are developed.

Implementation

Action research cycles were used to implement interventions, observe their effect over time, and re-evaluate their impact.

• Step 1: Categorization: Findings from video review were categorized as (1) protocol or equipment adjustments, (2) research topics, (3) tips and tricks or variations in care, or (4) needs for educational material or training programs. We also determined if the action targeted medical, nursing staff, or both.

• Step 2: Strategy and Implementation: The appropriate strategy was followed. Due to rotating staff, protocol adjustments required discussion at a larger staff meeting. Best practices were shared via email, newsletters, or posters. Training needs were addressed in training or educational material was developed. Sessions could also prompt expert consultations or research questions.

• Step 3: Evaluation: Subsequent video review sessions on the same procedure evaluated the implemented strategies. If no new findings arose, the cycle was closed. If changes were insufficient or discussions remained focused on the same aspects, the area of improvement was addressed in another cycle.

For more information regarding the Neoflix approach, click here.