In Situ Simulation and Clinical Outcomes in Infants Born Preterm.
Ritu Chitkara, Mihoko Bennett, Janine Bohnert, Nicole Yamada, Janene Fuerch, Louis P Halamek, Jenny Quinn, Kimber Padua, Jeffrey Gould, Jochen Profit, Xiao Xu, Henry C Lee
Author Information
Ritu Chitkara: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Center for Advanced Pediatric and Perinatal Education (CAPE), Stanford, CA. Electronic address: chitkara@stanford.edu.
Mihoko Bennett: California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA.
Janine Bohnert: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA.
Nicole Yamada: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Center for Advanced Pediatric and Perinatal Education (CAPE), Stanford, CA.
Janene Fuerch: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Center for Advanced Pediatric and Perinatal Education (CAPE), Stanford, CA.
Louis P Halamek: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Center for Advanced Pediatric and Perinatal Education (CAPE), Stanford, CA.
Jenny Quinn: California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA.
Kimber Padua: California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA.
Jeffrey Gould: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA.
Jochen Profit: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA.
Xiao Xu: Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT.
Henry C Lee: California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA; Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, CA.
OBJECTIVE: To evaluate impact of a multihospital collaborative quality improvement project implementing in situ simulation training for neonatal resuscitation on clinical outcomes for infants born preterm. STUDY DESIGN: Twelve neonatal intensive care units were divided into 4 cohorts; each completed a 15-month long program in a stepped wedge manner. Data from California Perinatal Quality Care Collaborative were used to evaluate clinical outcomes. Infants with very low birth weight between 22 through 31 weeks gestation were included. Primary outcome was survival without chronic lung disease (CLD); secondary outcomes included intubation in the delivery room, delivery room continuous positive airway pressure, hypothermia (<36��C) upon neonatal intensive care unit admission, severe intraventricular hemorrhage, and mortality before hospital discharge. A mixed effects multivariable regression model was used to assess the intervention effect. RESULTS: Between March 2017 and December 2020, a total of 2626 eligible very low birth weight births occurred at 12 collaborative participating sites. Rate of survival without CLD at participating sites was 74.1% in March to August 2017 and 76.0% in July to December 2020 (risk ratio 1.03; [0.94-1.12]); no significant improvement occurred during the study period for both participating and nonparticipating sites. The effect of in situ simulation on all secondary outcomes was stable. CONCLUSIONS: Implementation of a multihospital collaborative providing in situ training for neonatal resuscitation did not result in significant improvement in survival without CLD. Ongoing in situ simulations may have an impact on unit practice and unmeasured outcomes.
