The Effect of Simulation-Based Neonatal Emergency Team Training on Clinical Performance and Patient Outcome: A Systematic Review

Abstract

BackgroundA number of neonatal simulation-training programmes have been deployed during the last decade, and a growing number of studies have investigated effects of simulation-based team training. However, the body of evidence remains to be compiled. Therefore, we performed a systematic review on the effects of simulation-based team training on clinical performance and patient outcome.MethodsThe review was conducted according to the preferred reporting items for systematic review and meta-analysis (PRISMA). We included studies on team training in emergency neonatal settings with reported outcome on clinical performance and patient outcome. Two reviewers independently selected articles and assessed risk-of-bias using the Cochrane risk-of-bias tool 2.0 and the Newcastle-Ottawa quality assessment scale. Kirkpatricks’ model for evaluation of training programs provided the framework for a narrative synthesis.ResultsWe screened 1,434 titles and abstracts, evaluated 173 full-texts for eligibility, and included 24 studies. We identified only two studies with neonatal mortality outcome, and they had significant methodological limitations, and no conclusion could be reached regarding effects of simulation training in developed countries. Considering clinical performance, randomized studies showed improved team performance in simulated re-evaluations 3 and 6 months after the intervention.ConclusionsSimulation-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, since no studies were available from developed countries. Future research should include patient outcomes or clinical proxies of treatment quality whenever possible.