Traditional Poster Round
Background: : There is a paucity of studies evaluating the impact of simulation on teamwork during the transport of extremely low birth weight (ELBW) infants from the delivery room to the NICU, a crucial period that can impact ELBW infant morbidity and mortality.
Research Question: : We hypothesize that a multidisciplinary high-fidelity simulation curriculum will improve teamwork during resuscitation and transport of ELBW infants from the DR to the NICU, and decrease the time to complete key resuscitation and transport tasks.
Methodology: : A needs assessment was performed by obtaining a teamwork survey of all NICU providers and direct observation of 8 high risk deliveries using the Clinical Teamwork Scale (CTS), a tool that has been validated in a delivery room setting.
A prospective cohort study evaluated the effect of high-fidelity simulation scenarios involving ELBW infant resuscitation and transport upon teamwork. A total of 7 teams (each with 1 NICU fellow, 2 NICU nurses, and 1 RT) performed a series of 3 scenarios, spaced about 2 months apart. Debriefing focused on improving teamwork. All scenarios were videotaped and graded for teamwork skills by 3 independent raters using the CTS. Times to complete key resuscitation and transport tasks were recorded. Both teamwork scores and times to complete resuscitation tasks were compared between scenarios using a Student's t-test.
A post-intervention teamwork survey of all NICU providers was obtained 3 months later, and responses were compared to pre-intervention responses using a Student's t-test.
Results: : 70-83% of respondents in the pre-intervention survey (n=54) felt current teamwork was satisfactory to exceptional. However, on direct observation of high-risk deliveries, providers scored in the CTS average category (5.25-6.25 out of 0-10).
In the simulation cohort, there was no significant difference in CTS scores from Scenario 1 to 3. However, scenarios led by first-year fellows showed a trend towards improvement in all CTS categories (Figure 1). Overall, time to complete key resuscitation and transport tasks decreased, with a significant decrease in the time to attach the pulse oximeter (0.8 min to 0.6 min, p=0.02), to transfer the infant to the transport isolette (11.8 min to 8.7 min, p=0.05), and exit the DR (14.0 min to 10.4 min, p=0.02) (Figure 2).
Post-intervention survey responses (n=56) demonstrated an overall improvement in self-perception of teamwork behaviors following completion of the simulation curriculum (Figure 3).
Discussion/Conclusions: : A high-fidelity teamwork-based simulation curriculum decreased time to complete key clinical tasks in the resuscitation and transport of an ELBW infant. Given that decreasing time to provide post-resuscitative care to the ELBW infant has been proven to improve neonatal outcomes, it can be extrapolated that a teamwork-based high-fidelity simulation curriculum could play a vital role in improving delivery of care to these fragile infants.
There was no significant increase in teamwork scores; however, there was a trend towards increased teamwork in scenarios led by junior fellows.