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European journal of pediatrics
Nov, 2024;183 (11): 4981-4990.

Impact of in situ simulation training on quality of postnatal stabilization and resuscitation-a before-and-after, non-controlled quality improvement study.

Lukas P Mileder, Nariae Baik-Schneditz, Jasmin Pansy, Bernhard Schwaberger, Wolfgang Raith, Alexander Avian, Georg M Schm��lzer, Peter W��ckinger, Gerhard Pichler, Berndt Urlesberger
Author Information
  1. Lukas P Mileder: Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria. lukas.mileder@medunigraz.at.
  2. Nariae Baik-Schneditz: Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria.
  3. Jasmin Pansy: Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria.
  4. Bernhard Schwaberger: Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria.
  5. Wolfgang Raith: Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria.
  6. Alexander Avian: Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria.
  7. Georg M Schm��lzer: Northern Alberta Neonatal Program, University of Alberta, Edmonton, Canada.
  8. Peter W��ckinger: IIDepartment of Paediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria.
  9. Gerhard Pichler: Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria.
  10. Berndt Urlesberger: Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria.
PMID: 39311967 DOI: 10.1007/s00431-024-05781-3

Abstract

This study aimed to evaluate the impact of in situ simulation-based training on quality indicators of patient care at a level IV neonatal intensive care unit. A before-and-after, non-controlled quality improvement study was performed at the Division of Neonatology, Medical University of Graz. The educational intervention comprised a period of 4 months, with structured in situ simulation training delivered regularly for neonatal providers and nurses in interprofessional teams. The primary study outcome was the quality of non-technical skills and team interaction during actual postnatal stabilization and resuscitation. This was assessed using video recording during two 2-month observational phases before (pre-training) and after the educational intervention (post-training). Delivery room video recordings were assessed by two external, blinded neonatologists using the Anaesthetists' Non-Technical Skills (ANTS) score. Furthermore, we collected clinical patient data from video-recorded neonates during the pre- and post-training periods, and training participants' individual knowledge of neonatal resuscitation guidelines was assessed using a before- and after-questionnaire. A total of 48 healthcare professionals participated in 41 in situ simulation trainings. The level of non-technical skills and team interaction was already high in the pre-training period, and it did not further improve afterwards. Nonetheless, we observed a significant increase in the teamwork event "evaluation of plans" (0.5 [IQR 0.0-1.0] versus 1.0 [1.0-2.0], p���=���0.049). Following the educational intervention, training participants' knowledge of neonatal resuscitation guidelines significantly improved, although there were no differences in secondary clinical outcome parameters.
CONCLUSION: We have successfully implemented a neonatal in situ simulation training programme. The observed improvement in one teamwork event category in the post-training period demonstrates the effectiveness of the training curriculum, while also showing the potential of in situ simulation training for improving postnatal care and, ultimately, patient outcome.
WHAT IS KNOWN: ��� In situ simulation-based training is conducted in the real healthcare environment, thus promoting experiential learning which is closely aligned with providers' actual work. ��� In situ simulation-based training may offer an additional benefit for patient outcomes in comparison to other instructional methodologies.
WHAT IS NEW: ��� This observational study investigated translational patient outcomes in preterm neonates before and after delivery of high-frequency in situ simulation-based training at a level IV neonatal intensive care unit. ��� There was a significant increase in the frequency of one major teamwork event following the delivery of in situ simulation-based training, indicating a notable improvement in the non-technical skills domain, which is closely linked to actual team performance.

Keywords

In situ training Neonate Non-technical skills Postnatal stabilization Preterm Resuscitation Simulation training Video recording

References

  1. Gaba DM (2004) The future vision of simulation in health care. Qual Saf Health Care 13(Suppl 1):i2���i10. https://doi.org/10.1136/qhc.13.suppl_1.i2 [DOI: 10.1136/qhc.13.suppl_1.i2]
  2. Halamek LP (2008) The simulated delivery-room environment as the future modality for acquiring and maintaining skills in fetal and neonatal resuscitation. Semin Fetal Neonatal Med 13(6):448���453. https://doi.org/10.1016/j.siny.2008.04.015 [DOI: 10.1016/j.siny.2008.04.015]
  3. Knowland VCP, Thomas MSC (2014) Educating the adult brain: how the neuroscience of learning can inform educational policy. Int Rev Educ 60(1):99���122. https://doi.org/10.1007/s11159-014-9412-6 [DOI: 10.1007/s11159-014-9412-6]
  4. Zigmont JJ, Kappus LJ, Sudikoff SN (2011) Theoretical foundations of learning through simulation. Semin Perinatol 35(2):47���51. https://doi.org/10.1053/j.semperi.2011.01.002 [DOI: 10.1053/j.semperi.2011.01.002]
  5. Yousef N, Moreau R, Soghier L (2022) Simulation in neonatal care: towards a change in traditional training? Eur J Pediatr 181(4):1429���1436. https://doi.org/10.1007/s00431-022-04373-3 [DOI: 10.1007/s00431-022-04373-3]
  6. Wagner M, Heimberg E, Mileder LP, Staffler A, Paulun A, L��llgen RM, German-speaking Research Association for Simulation in Pediatrics (GRASP) (2018) Status Quo in pediatric and neonatal simulation in four central European regions: the DACHS survey. Simul Healthc 13(4):247���252. https://doi.org/10.1097/SIH.0000000000000296 [DOI: 10.1097/SIH.0000000000000296]
  7. Sawyer T, Stavroudis TA, Ades A, Dadiz R, Dammann CEL, Halamek LP, Moussa A, Soghier L, Gupta A, Aliaga S, Umoren R, French H, Organization of Neonatal-Perinatal Training Program Directors Task Force on Simulation (2020) Simulation in neonatal-perinatal medicine fellowship programs. Am J Perinatol 37(12):1258���1263. https://doi.org/10.1055/s-0039-1693465 [DOI: 10.1055/s-0039-1693465]
  8. Madar J, Roehr CC, Ainsworth S, Ersdal H, Morley C, R��diger M, Sk��re C, Szczapa T, Te Pas A, Trevisanuto D, Urlesberger B, Wilkinson D, Wyllie JP (2021) European Resuscitation Council Guidelines 2021: newborn resuscitation and support of transition of infants at birth. Resuscitation 161:291���326. https://doi.org/10.1016/j.resuscitation.2021.02.014 [DOI: 10.1016/j.resuscitation.2021.02.014]
  9. Patterson MD, Blike GT, Nadkarni VM (2008) In situ simulation: challenges and results. In: Henriksen K, Battles JB, Keyes MA, Grady ML (eds) Advances in patient safety: new directions and alternative approaches (Vol. 3: Performance and Tools). Agency for Healthcare Research and Quality, Rockville, United States of America. http://www.ncbi.nlm.nih.gov/books/NBK43682 Accessed 13 June 2024
  10. O���Leary F, McGarvey K, Christoff A, Major J, Lockie F, Chayen G, Vassiliadis J, Wharton S (2014) Identifying incidents of suboptimal care during paediatric emergencies-an observational study utilising in situ and simulation centre scenarios. Resuscitation 85(3):431���436. https://doi.org/10.1016/j.resuscitation.2013.12.001 [DOI: 10.1016/j.resuscitation.2013.12.001]
  11. Mileder LP, Schwaberger B, Baik-Schneditz N, Ribitsch M, Pansy J, Raith W, Rohrleitner A, Mesaric G, Urlesberger B (2023) Sustained decrease in latent safety threats through regular interprofessional in situ simulation training of neonatal emergencies. BMJ Open Qual 12(4):e002567. https://doi.org/10.1136/bmjoq-2023-002567 [DOI: 10.1136/bmjoq-2023-002567]
  12. Gro��e Lordemann A, Sommerfeldt D, Mileder L (2024) [Latent safety threats in a pediatric emergency department: using in situ simulation to test a new trauma room concept]. Z Evid Fortbild Qual Gesundhwes:S1865���9217(24)00053���9. https://doi.org/10.1016/j.zefq.2024.03.005 . Online ahead of print.
  13. Calhoun AW, Cook DA, Genova G, Motamedi SMK, Waseem M, Carey R, Hanson A, Chan JCK, Camacho C, Harwayne-Gidansky I, Walsh B, White M, Geis G, Monachino AM, Maa T, Posner G, Li DL, Lin Y (2024) Educational and patient care impacts of in situ simulation in healthcare: a systematic review. Simul Healthc 19(1S):S23���S31. https://doi.org/10.1097/SIH.0000000000000773 [DOI: 10.1097/SIH.0000000000000773]
  14. Stark AR, Pursley DM, Papile LA, Eichenwald EC, Hankins CT, Buck RK, Wallace TJ, Bondurant PG, Faster NE (2023) Standards for levels of neonatal care: II, III, and IV. Pediatrics 151(6):e2023061957. https://doi.org/10.1542/peds.2023-061957 [DOI: 10.1542/peds.2023-061957]
  15. Eppich W, Cheng A (2015) Promoting Excellence and Reflective Learning in Simulation (PEARLS): development and rationale for a blended approach to health care simulation debriefing. Simul Healthc 10(2):106���115. https://doi.org/10.1097/SIH.0000000000000072 [DOI: 10.1097/SIH.0000000000000072]
  16. Fletcher G, Flin R, McGeorge P, Glavin R, Maran N, Patey R (2003) Anaesthetists��� Non-Technical Skills (ANTS): evaluation of a behavioural marker system. Br J Anaesth 90(5):580���588. https://doi.org/10.1093/bja/aeg112 [DOI: 10.1093/bja/aeg112]
  17. Kang J, Hu J, Yan C, Xing X, Tu S, Zhou F (2024) Development and applications of the Anaesthetists��� Non-Technical Skills behavioural marker system: a systematic review. BMJ Open 14(3):e075019. https://doi.org/10.1136/bmjopen-2023-075019 [DOI: 10.1136/bmjopen-2023-075019]
  18. Thomas EJ, Williams AL, Reichman EF, Lasky RE, Crandell S, Taggart WR (2010) Team training in the neonatal resuscitation program for interns: teamwork and quality of resuscitations. Pediatrics 125(3):539���546. https://doi.org/10.1542/peds.2009-1635 [DOI: 10.1542/peds.2009-1635]
  19. McGaghie WC, Draycott TJ, Dunn WF, Lopez CM, Stefanidis D (2011) Evaluating the impact of simulation on translational patient outcomes. Simul Healthc 6 Suppl(Suppl):S42-S47. https://doi.org/10.1097/SIH.0b013e318222fde9
  20. Eckels M, Zeilinger T, Lee HC, Bergin J, Halamek LP, Yamada N, Fuerch J, Chitkara R, Quinn J (2020) A neonatal intensive care unit���s experience with implementing an in-situ simulation and debriefing patient safety program in the setting of a quality improvement collaborative. Children (Basel) 7(11):202. https://doi.org/10.3390/children7110202 [DOI: 10.3390/children7110202]
  21. Rivera EK, Siple LM, Wicks EJ, Johnson HS, Skov CM (2020) In situ neonatal mock codes: assessing the impact. Neonatal Netw 39(1):29���34. https://doi.org/10.1891/0730-0832.39.1.29 [DOI: 10.1891/0730-0832.39.1.29]
  22. Johnsen BH, Westli HK, Espevik R, Wisborg T, Bratteb�� G (2017) High-performing trauma teams: frequency of behavioral markers of a shared mental model displayed by team leaders and quality of medical performance. Scand J Trauma Resusc Emerg Med 25(1):109. https://doi.org/10.1186/s13049-017-0452-3 [DOI: 10.1186/s13049-017-0452-3]
  23. Weller JM, Mahajan R, Fahey-Williams K, Webster CS (2024) Teamwork matters: team situation awareness to build high-performing healthcare teams, a narrative review. Br J Anaesth 132(4):771���778. https://doi.org/10.1016/j.bja.2023.12.035 [DOI: 10.1016/j.bja.2023.12.035]
  24. Sawyer T, Burke C, McMullan DM, Chan T, Valdivia H, Yalon L, Roberts J (2019) Impacts of a pediatric extracorporeal cardiopulmonary resuscitation (ECPR) simulation training program. Acad Pediatr 19(5):566���571. https://doi.org/10.1016/j.acap.2019.01.005 [DOI: 10.1016/j.acap.2019.01.005]
  25. Ajmi SC, Advani R, Fjetland L, Dehli Kurz K, Lindner T, Qvindesland SA, Ersdal H, Goyal M, Kval��y JT, Kurz M (2019) Reducing door-to-needle times in stroke thrombolysis to 13 min through protocol revision and simulation training: a quality improvement project in a Norwegian stroke centre. BMJ Qual Saf 28(11):939���948. https://doi.org/10.1136/bmjqs-2018-009117 [DOI: 10.1136/bmjqs-2018-009117]
  26. Bogne Kamdem V, Daelemans C, Englert Y, Morin F, Sansregret A (2021) Using simulation team training with human���s factors components in obstetrics to improve patient outcome: a review of the literature. Eur J Obstet Gynecol Reprod Biol 260:159���165. https://doi.org/10.1016/j.ejogrb.2021.03.015 [DOI: 10.1016/j.ejogrb.2021.03.015]
  27. Brogaard L, Hvidman L, Esberg G, Finer N, Hjorth-Hansen KR, Manser T, Kierkegaard O, Uldbjerg N, Henriksen TB (2022) Teamwork and adherence to guideline on newborn resuscitation-video review of neonatal interdisciplinary teams. Front Pediatr 10:828297. https://doi.org/10.3389/fped.2022.828297 [DOI: 10.3389/fped.2022.828297]
  28. Oei JL, Finer NN, Saugstad OD, Wright IM, Rabi Y, Tarnow-Mordi W, Rich W, Kapadia V, Rook D, Smyth JP, Lui K, Vento M (2018) Outcomes of oxygen saturation targeting during delivery room stabilisation of preterm infants. Arch Dis Child Fetal Neonatal Ed 103(5):F446���F454. https://doi.org/10.1136/archdischild-2016-312366 [DOI: 10.1136/archdischild-2016-312366]
  29. Bruckner M, Mileder LP, Richter A, Baik-Schneditz N, Schwaberger B, Binder-Heschl C, Urlesberger B, Pichler G (2020) Association between regional tissue oxygenation and body temperature in term and preterm infants born by caesarean section. Children (Basel) 7(11):205. https://doi.org/10.3390/children7110205 [DOI: 10.3390/children7110205]
  30. Stark CF, Gibbs RS, Freedman WL (1990) Comparison of umbilical artery pH and 5-minute Apgar score in the low-birth-weight and very-low-birth-weight infant. Am J Obstet Gynecol 163(3):818���823. https://doi.org/10.1016/0002-9378(90)91075-n [DOI: 10.1016/0002-9378(90)91075-n]
  31. O���Donnell CP, Kamlin CO, Davis PG, Carlin JB, Morley CJ (2006) Interobserver variability of the 5-minute Apgar score. J Pediatr 149(4):486���489. https://doi.org/10.1016/j.jpeds.2006.05.040 [DOI: 10.1016/j.jpeds.2006.05.040]
  32. Niemuth M, K��ster H, Simma B, Rozycki H, R��diger M; European Society for Paediatric Research (ESPR) Neonatal Resuscitation Section Writing Group; Solev��g AL (2021) A critical appraisal of tools for delivery room assessment of the newborn infant. Pediatr Res. https://doi.org/10.1038/s41390-021-01896-7 . Online ahead of print.
  33. Theilen U, Fraser L, Jones P, Leonard P, Simpson D (2017) Regular in-situ simulation training of paediatric Medical Emergency Team leads to sustained improvements in hospital response to deteriorating patients, improved outcomes in intensive care and financial savings. Resuscitation 115:61���67. https://doi.org/10.1016/j.resuscitation.2017.03.031 [DOI: 10.1016/j.resuscitation.2017.03.031]
  34. Andreatta P, Saxton E, Thompson M, Annich G (2011) Simulation-based mock codes significantly correlate with improved pediatric patient cardiopulmonary arrest survival rates. Pediatr Crit Care Med 12(1):33���38. https://doi.org/10.1097/PCC.0b013e3181e89270 [DOI: 10.1097/PCC.0b013e3181e89270]
  35. Awadhare P, Barot K, Frydson I, Balakumar N, Doerr D, Bhalala U (2023) Impact of quality improvement bundle on compliance with resuscitation guidelines during in-hospital cardiac arrest in children. Crit Care Res Pract 6875754. https://doi.org/10.1155/2023/6875754
  36. Cheng A, Lang TR, Starr SR, Pusic M, Cook DA (2014) Technology-enhanced simulation and pediatric education: a meta-analysis. Pediatrics 133(5):e1313���e1323. https://doi.org/10.1542/peds.2013-2139 [DOI: 10.1542/peds.2013-2139]
  37. Mileder LP, Urlesberger B, Szyld EG, Roehr CC, Schm��lzer GM (2014) Simulation-based neonatal and infant resuscitation teaching: a systematic review of randomized controlled trials. Klin Padiatr 226(5):259���267. https://doi.org/10.1055/s-0034-1372621 [DOI: 10.1055/s-0034-1372621]
  38. Kennedy CC, Cannon EK, Warner DO, Cook DA (2014) Advanced airway management simulation training in medical education: a systematic review and meta-analysis. Crit Care Med 42(1):169���178. https://doi.org/10.1097/CCM.0b013e31829a721f [DOI: 10.1097/CCM.0b013e31829a721f]
  39. Goodacre S (2015) Uncontrolled before-after studies: discouraged by Cochrane and the EMJ. Emerg Med J 32(7):507���508. https://doi.org/10.1136/emermed-2015-204761 [DOI: 10.1136/emermed-2015-204761]
  40. Gordon L, Reed C, Sorensen JL, Schulthess P, Strandbygaard J, Mcloone M, Grantcharov T, Shore EM (2022) Perceptions of safety culture and recording in the operating room: understanding barriers to video data capture. Surg Endosc 36(6):3789���3797. https://doi.org/10.1007/s00464-021-08695-5 [DOI: 10.1007/s00464-021-08695-5]

MeSH Term

Humans
Quality Improvement
Infant, Newborn
Simulation Training
Resuscitation
Clinical Competence
Intensive Care Units, Neonatal
Female
Male
Patient Care Team
Video Recording
Neonatology
Adult
Journal Article Observational Study
Article has an altmetric score of 8

Word Cloud

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