P2.J183: Utilizing an in Unit Simulation Station to Improve Technical and Behavioral Skills of a Neonatal Resuscitation Team

Purpose/Objectives: At our academic children’s hospital, there are over 170 total physicians, nurses, nurse practitioner, and respiratory care staff who can attend a newborn delivery, and over 60 different providers who could manage the airway not including trainees. These numbers lead to over 100 billion different team permutations that could attend a neonatal resuscitation in the delivery room at any given time.
As part of a quality improvement program at our hospital, resuscitations in the operative delivery rooms are recorded and those requiring positive pressure ventilation (PPV) are reviewed. Baseline data analysis of the 8 months prior to the opening of the NICU Simulation Station showed that mask PPV in the delivery room was performed correctly only 11% of the time, and patients were successfully intubated on the first attempt 50% of the time.

Design/Methods: We created a NICU-based Simulation Station that consists of a functioning radiant warmer, neonatal code cart, T-piece resuscitator, face masks and intubation supplies for term and preterm manikins, two full-term manikins, one preterm manikin, and a respiratory function monitor. The station is located in the NICU and is intended to be used by all team members who attend deliveries, including trainees. Delivery team huddles occur twice daily (once per shift) at the simulation station. By conducting the huddles at the radiant warmer, team members rehearse their roles, practice using resuscitation-specific briefing checklists, and visualize themselves in a resuscitation together. The team members assigned to manage the airway during deliveries must complete a mask PPV exercise and intubation exercise at the beginning of each shift. For anticipated complex deliveries, the station is utilized for just-in-time training to practice technical and behavioral skills prior to the resuscitation.

Results: The Simulation Station opened on March 18, 2024. Since opening, it has been used 28 times for team huddles, 9 times for just-in-time training, 110 times for mask PPV exercises, and 98 times for intubation exercises.

Recorded resuscitations from our delivery rooms will be analyzed for 8 months after the opening of the simulation station (through November 2024). The goal is to have mask PPV performed correctly 70% of the time and delivery room intubations be successful 70% of the time on the first attempt.

Conclusion/Discussion: Just-in-time training is a proven methodology to reinforce skills and improve success for a variety of technical procedures. The simulation station will aid in improving technical and behavioral skills of our neonatal resuscitation teams.

The central location of the station allows it to be utilized by all NICU staff. Further standards will be created on how best to have members outside of the delivery teams utilize the station to improve patient safety including new staff training and mock codes.