Traditional Poster Round
Context: : Historically, neonatal/pediatric transport teams have relied on didactic and procedural skills training, along with NRP, PALS, and ACLS to remain competent in the field.1, 2 Incorporating simulation into yearly curriculum has the ability to enhance the skills and training acquired by placing learners into a controlled and realistic environment. After spending some time with our neonatal simulation team, the leadership for the neonatal/pediatric transport team approached us to incorporate simulation into their practice. We built a simulation program that provides high risk-low volume scenarios to high functioning neonatal/pediatric transport teams to allow for practice of rare diagnoses and procedures. Additionally, the simulation environment aims to improve the communication skills between the receiving tertiary care facility, the transport team members, and the referring hospital team.
Description: : Our team approach to simulation was to enhance the skills, teamwork, and communication of the team rather than measure competency. Scenarios were designed for advanced skill teams based on the needs perceived by their leadership. Transport teams were made up of a RN, RT, and a NNP, when available. Expectations were set prior to the program to assure 100% participation, availability of the teams transport supply bags and transporter, and that each participant come in uniform and perform as if on the clock. Each session was led by the simulation team which consisted of simulation educators and neonatologists, along with embedded participants. Eight sessions were provided throughout the year to accommodate each learner twice a year. Each team started with a short scenario highlighting NRP prior to rotating through 3 high acuity scenarios followed by a facilitated debriefing. Each learner completed an evaluation at the conclusion of the session.
Observation/Evaluation: : The simulation team recognized early that we had provided scenarios that were larger than needed, so we then re-framed our focus on basic NRP resuscitation, and built on that. Based on issues identified in simulation, certain policies and processes were modified to provide best care. Participants reported, through anonymous evaluations that this simulation program proved to be the best learning tool they had encountered. Providing them with realistic scenarios, environments, and interactions added to the experience. By far, the greatest feedback revolved around the constructive facilitated debriefing after each scenario that reinforced both the good aspects along with aspects that could be improved upon. After 18 months and continued support, the next step was to incorporate pediatric scenarios into each session, facilitated by our pediatric intensivist colleagues. The pediatric group completed formal training offered by neonatal simulation team. During each sim session we provided 2 neonatal and 2 pediatric scenarios that were facilitated by their respective intensivists. In addition to the new scenario template we then integrated the transport team’s mobile intensive care unit (MICU) for realism.
Discussion: : Neonatal/pediatric transport team providers must remain proficient in all areas of pediatrics. Simulation based training is one way to practice the cognitive, technical, behavioral and communication skills to efficiently and effectively manage critically ill patients. Our approach with simulation is to allow for practice of infrequently seen diagnoses and procedures rather than to use the modality as a competency or validation.