Reed D J W, Hermelin R L, Kennedy C S, Sharma J
Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA.
University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
J Perinatol. 2017 Apr;37(4):461-464. doi: 10.1038/jp.2016.238. Epub 2017 Jan 5.
Simulation training improves individual clinician confidence, performance and self-efficacy in resuscitation and procedural training experiences. The reality of resuscitation experiences in the neonatal intensive care unit (NICU) is that they are team-accomplished events. However, limited data exist on team-based simulation training (TBST) in the NICU. We report the experience of TBST over a 4-year period.
This is a retrospective report of 65 TBST events in a 71-bed Level IV NICU at a regional subspecialty children's hospital. Participants were more than 500 NICU staff, including neonatal/cardiac/surgical attendings, neonatal fellows, neonatal nurse practitioners, pediatric residents, registered nurses and respiratory therapists. Background work, common case scenarios, training objectives and learning opportunities were reported, along with discipline-specific, and team and system areas for improvement. Qualitative, subjective data were tracked and efforts at collecting quantitative, objective data are ongoing.
Seventy-five TBST events were scheduled from November 2010 through December 2014; 10 of these were canceled. TBST events occurred both night (n=23) and day (n=42), and also on weekends (n=19), using high-fidelity (n=42) and low-fidelity (n=23) systems. Resuscitation team participants at each TBST were 12-30 providers and staff. The duration of each TBST event was 30-65 min including debriefing. Systems issues were identified and corrected, including problems activating the code pathway, issues using a pager activation system and confusion over resuscitation team roles and responsibilities. Educational needs were addressed, focused on topic areas that included arrhythmias and use of extracorporeal cardiopulmonary resuscitation.
With appropriate planning and implementation, TBST is feasible and realistic in a busy NICU.
模拟训练可提高临床医生在复苏及操作训练中的个人信心、表现和自我效能。新生儿重症监护病房（NICU）的复苏实际是团队协作完成的事件。然而，关于NICU中基于团队的模拟训练（TBST）的数据有限。我们报告了4年期间TBST的经验。
这是对一家地区性专科儿童医院拥有71张床位的IV级NICU中65次TBST事件的回顾性报告。参与者为500多名NICU工作人员，包括新生儿/心脏/外科主治医生、新生儿研究员、新生儿执业护士、儿科住院医师、注册护士和呼吸治疗师。报告了背景工作、常见病例场景、训练目标和学习机会，以及特定学科、团队和系统的改进领域。对定性、主观数据进行了跟踪，目前正在努力收集定量、客观数据。
2010年11月至2014年12月共安排了75次TBST事件；其中10次被取消。TBST事件在夜间（n = 23）和白天（n = 42）均有发生，周末也有（n = 19），使用了高仿真系统（n = 42）和低仿真系统（n = 23）。每次TBST的复苏团队参与者为12 - 30名医护人员。每次TBST事件的时长为30 - 65分钟，包括汇报环节。识别并纠正了系统问题，包括启动急救流程的问题、使用寻呼机激活系统的问题以及对复苏团队角色和职责的混淆。满足了教育需求，重点关注心律失常和体外心肺复苏使用等主题领域。
通过适当的规划和实施，TBST在繁忙的NICU中是可行且实际的。
