Lessons Learned from a Collaborative to Develop a Sustainable Simulation-Based Training Program in Neonatal Resuscitation: Simulating Success

Abstract

Newborn resuscitation requires a multidisciplinary team effort to deliver safe, effective and efficient care. California Perinatal Quality Care Collaborative’s Simulating Success program was designed to help hospitals implement on-site simulation-based neonatal resuscitation training programs. Partnering with the Center for Advanced Pediatric and Perinatal Education at Stanford, Simulating Success engaged hospitals over a 15 month period, including three months of preparatory training and 12 months of implementation. The experience of the first cohort (Children’s Hospital of Orange County (CHOC), Sharp Mary Birch Hospital for Women and Newborns (SMB) and Valley Children’s Hospital (VCH)), with their site-specific needs and aims, showed that a multidisciplinary approach with a sound understanding of simulation methodology can lead to a dynamic simulation program. All sites increased staff participation. CHOC reduced latent safety threats measured during team exercises from 4.5 to two per simulation while improving debriefing skills. SMB achieved 100% staff participation by identifying unit-specific hurdles within in situ simulation. VCH improved staff confidence level in responding to neonatal codes and proved feasibility of expanding simulation across their hospital system. A multidisciplinary approach to quality improvement in neonatal resuscitation fosters engagement, enables focus on patient safety rather than individual performance, and leads to identification of system issues.

WITHDRAWN: Quality Improvement for Neonatal Resuscitation and Delivery Room Care

“…Changes shown to be impactful in the simulations using QI methods could then be adopted into clinical care. QI programs anchored on serial on-site neonatal resuscitation simulation trainings led to increased staff participation, improved staff confidence, and perhaps most importantly, the identification of local context-specific latent safety threats 50 , 51 . For example, if a specific piece of equipment is not appropriately ready during repeated simulations, interventions to make the equipment easier to find and prepare will likely prevent adverse events in actual clinical care.…”

Quality improvement for neonatal resuscitation and delivery room care

“…QI programs anchored on serial on-site neonatal resuscitation simulation trainings led to increased staff participation, improved staff confidence, and perhaps most importantly, the identification of local context-specific latent safety threats. 50 , 51 For example, if a specific piece of equipment is not appropriately ready during repeated simulations, interventions to make the equipment easier to find and prepare will likely prevent adverse events in actual clinical care.…”

The Debriefing Assessment in Real Time (DART) tool for simulation-based medical education

“…DART (Fig. 1) was adapted from observing effective debriefing approaches in nonmedical industries by faculty from the Center for Advanced Pediatric and Perinatal Education (CAPE) [11]. DART purports to measure the conversational interactions between debriefers and learners using a cumulative scoring of discrete contributions.…”

“…In contrast with other quantitative instruments such as DE-CODE, which was developed primarily for research, DART aims to make a real-time additional or alternative assessment for faculty development [12]. DART can be downloaded from the National Library of Medicine using an open access link from previous papers describing its use [11,13]. In summary, this study aims to evaluate the reliability and external validity (using Kane's framework) of the DART [14,15].…”