Simulation-Based Neonatal Resuscitation Team Training: A Systematic Review

Abstract

CONTEXT: Several neonatal simulation-training programs have been deployed during the last decade, and in a growing number of studies, researchers have investigated the effects of simulation-based team training. This body of evidence remains to be compiled. OBJECTIVE: We performed a systematic review of the effects of simulation-based team training on clinical performance and patient outcome. DATA SOURCES: Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library. STUDY SELECTION: Two authors included studies of team training in critical neonatal situations with reported outcomes on clinical performance and patient outcome. DATA EXTRACTION: Two authors extracted data using a predefined template and assessed risk of bias using the Cochrane risk-of-bias tool 2.0 and the Newcastle-Ottawa quality assessment scale. RESULTS: We screened 1434 titles and abstracts, evaluated 173 full texts for eligibility, and included 24 studies. We identified only 2 studies with neonatal mortality outcomes, and no conclusion could be reached regarding the effects of simulation training in developed countries. Considering clinical performance, randomized studies revealed improved team performance in simulated re-evaluations 3 to 6 months after the intervention. LIMITATIONS: Meta-analysis was impossible because of heterogenous interventions and outcomes. Kirkpatrick’s model for evaluating training programs provided the framework for a narrative synthesis. Most included studies had significant methodologic limitations. CONCLUSIONS: Simulation-based team training in neonatal resuscitation improves team performance and technical performance in simulation-based evaluations 3 to 6 months later. The current evidence was insufficient to conclude on neonatal mortality after simulation-based team training because no studies were available from developed countries. In future work, researchers should include patient outcomes or clinical proxies of treatment quality whenever possible.

Simulation in neonatal care: towards a change in traditional training?

“…In a neonatal resuscitation setting, teams are usually multidisciplinary, with professionals from different backgrounds often coming together to work for the first time. Team behavior and team communications significantly influence the quality of neonatal resuscitation, and have been implicated in the majority of medical errors, with negative consequences on perinatal morbidity and mortality [ 52 , 53 ]. Simulation-based training can be used to train non-technical skills such as communication, teamwork, and leadership to improve team performance and team coordination [ 8 ].…”

“…There are few studies evaluating team performance after simulation training in neonatal resuscitation [ 53 , 54 ]. A recent review found significantly improved team performance in simulated re-evaluation 3 and 6 months after simulation training [ 53 ].…”

“…Medical simulation strives to improve patient outcomes. However, data directly focusing on direct patient outcomes are few, especially in neonatal care [ 53 , 55 ]. In addition, outcomes such as improvement of non-practical skills and human factors are difficult to evaluate and may be underreported [ 55 , 56 ].…”

“…Available reports on the effect of simulation on direct patient outcomes in neonatal care are often limited to single center studies. Several reviews on the impact of simulation on neonatal mortality and morbidity have not been able to reveal effects of team training on neonatal outcomes because of insufficient or poor quality data [ 53 , 61 ].…”

Improving Newborn Resuscitation by Making Every Birth a Learning Event

“…To increase the use of peer-to-peer support at the bedside, standard resuscitation training is frequently paired with team training [ 47 ]. A systematic review of team training in neonatal emergencies demonstrated that team training improves performance in simulations, and thus may improve performance at the bedside [ 48 ]. One observational analysis of team behavior during clinical newborn resuscitations in the United States illustrated the following three fundamental concepts: communication (i.e., information sharing and inquiry), management (i.e., workload and vigilance), and leadership (i.e., assertion, intentions shared, evaluation of plans) [ 49 ].…”