Impact of in situ simulation training on quality of postnatal stabilization and resuscitation

Impact of In Situ Simulation Training on Postnatal Stabilization and Resuscitation: Enhancing Neonatal Care Through Innovative Training

Simulation-based training (SBT) has become an essential educational tool, especially in dynamic medical fields like anesthesia, emergency medicine, and critical care. Neonatal-perinatal medicine, given the high risks associated with the immediate care of depressed or non-vigorous newborns, is a prime candidate for SBT. This form of training offers a structured learning environment that fosters both technical and non-technical skills development through active participation and experimentation, a key component of adult learning.

This blog entry explores the impact of in situ SBT on neonatal care at the Medical University of Graz, specifically targeting postnatal stabilization and resuscitation. The study aimed to assess improvements in team performance, clinical outcomes, and adherence to resuscitation guidelines through a before-and-after, non-controlled quality improvement study.

Simulation-Based Training in Neonatal-Perinatal Medicine

In situ SBT differs from traditional center-based simulation by placing training directly in the healthcare environment, using on-duty staff as participants. This method closely mimics real-world clinical scenarios, offering advantages such as heightened realism and greater learning efficiency for healthcare providers. This approach can also highlight potential safety threats and improve the quality of patient care by allowing teams to practice complex skills under conditions that resemble their everyday work.

Research has shown that SBT, particularly in situ, positively affects patient outcomes, reducing mortality and morbidity rates in neonatal settings. Despite these potential benefits, few studies have explored the direct impact of in situ SBT on postnatal stabilization and resuscitation—a gap this study sought to fill.

Study Design and Key Findings

The study's educational intervention spanned four months, with healthcare professionals participating in an average of 2.6 simulation sessions per week. Although slightly below the target of three to five sessions, this frequency was impressive given the demands of clinical responsibilities. The training aimed to enhance team dynamics, communication, and non-technical skills critical to neonatal resuscitation.

Key findings from the study included:

High Baseline Non-Technical Skills: Both pre- and post-training, the level of non-technical skills such as task management, decision-making, and situational awareness was already high. This left little room for improvement, suggesting that the NICU staff had strong team interaction skills even before the intervention.
Improvement in “Evaluation of Plans”: Despite the high baseline skills, there was a significant increase in the teamwork event “evaluation of plans” post-training. This is crucial, as regular reassessment of diagnostic and therapeutic strategies is essential for avoiding clinical errors and ensuring high-quality neonatal care.
Knowledge Gains: Following the in situ SBT, participants demonstrated a significant improvement in their knowledge of neonatal resuscitation guidelines. This finding underscores the effectiveness of SBT in enhancing cognitive learning, a crucial complement to technical skills.
No Change in Clinical Outcomes: Surprisingly, the study did not find significant changes in secondary clinical outcomes like the time to first ventilation breath or heart rate assessment. However, timeframes for these measures were within recommended limits, suggesting that the baseline level of care was already strong. Moreover, patient outcomes, such as 5-minute Apgar scores and in-hospital mortality, did not differ significantly between the pre- and post-training phases.
Challenges with Hypothermia and Apgar Scores: The study noted an increase in mild hypothermia cases and slightly lower 5-minute Apgar scores in the post-training period. However, these findings were likely influenced by the lower birth weights of the neonates in the post-training group. Adjusting for these variables, the differences were less pronounced, and no significant impact on long-term clinical outcomes was found.

The Broader Implications of In Situ SBT

The improvement in teamwork dynamics—particularly the evaluation of plans—suggests that in situ SBT can positively influence team performance in neonatal settings. Studies across various medical disciplines have shown that enhanced teamwork through simulation training leads to better protocol adherence, reduced response times, and improved clinical outcomes in critical situations such as neonatal resuscitation.

While the study did not identify significant differences in clinical outcomes, the high baseline of team interaction, combined with the positive changes observed in specific teamwork behaviors, highlights the value of continuous training. Regular re-evaluation of plans, as seen in the study, can help prevent fixation errors, a common cause of clinical misjudgments, and improve overall patient care.

Limitations and Future Directions

As with any study, there are limitations. First, the study's small sample size, particularly the lower-than-expected number of neonates requiring resuscitation, may have impacted the findings. Additionally, video recording of clinical events may have influenced staff behavior, a factor that could not be entirely controlled. The study also relied on the Anaesthetists’ Non-Technical Skills (ANTS) score, which was not specifically designed for neonatal resuscitation settings.

Despite these limitations, the findings offer valuable insights into the benefits of in situ SBT. The increase in knowledge and specific improvements in teamwork behaviors highlight the potential for this type of training to enhance neonatal care quality. Controlled studies with larger sample sizes and longer observation periods are necessary to fully understand the impact of simulation-based training on neonatal outcomes.

Conclusion

The study successfully implemented a robust in situ simulation training program, demonstrating its potential to enhance team dynamics and improve knowledge retention in neonatal resuscitation settings. Although no significant changes in clinical outcomes were observed, the improvements in teamwork and cognitive skills are promising indicators of SBT’s value. As simulation-based training becomes an integral part of neonatal care, further research will help refine these programs and solidify their role in improving patient outcomes.

Simulation-based training, especially when delivered in the actual healthcare environment, holds great promise for advancing neonatal care. By fostering stronger team dynamics and ensuring adherence to resuscitation protocols, it can help healthcare providers deliver better care to some of the most vulnerable patients—newborns in need of immediate stabilization.