Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria.
Paediatric Simulation Group Graz, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
Eur J Pediatr. 2024 Nov;183(11):4981-4990. doi: 10.1007/s00431-024-05781-3. Epub 2024 Sep 23.
This study aimed to evaluate the impact of in situ simulation-based training on quality indicators of patient care at a level IV neonatal intensive care unit. A before-and-after, non-controlled quality improvement study was performed at the Division of Neonatology, Medical University of Graz. The educational intervention comprised a period of 4 months, with structured in situ simulation training delivered regularly for neonatal providers and nurses in interprofessional teams. The primary study outcome was the quality of non-technical skills and team interaction during actual postnatal stabilization and resuscitation. This was assessed using video recording during two 2-month observational phases before (pre-training) and after the educational intervention (post-training). Delivery room video recordings were assessed by two external, blinded neonatologists using the Anaesthetists' Non-Technical Skills (ANTS) score. Furthermore, we collected clinical patient data from video-recorded neonates during the pre- and post-training periods, and training participants' individual knowledge of neonatal resuscitation guidelines was assessed using a before- and after-questionnaire. A total of 48 healthcare professionals participated in 41 in situ simulation trainings. The level of non-technical skills and team interaction was already high in the pre-training period, and it did not further improve afterwards. Nonetheless, we observed a significant increase in the teamwork event "evaluation of plans" (0.5 [IQR 0.0-1.0] versus 1.0 [1.0-2.0], p = 0.049). Following the educational intervention, training participants' knowledge of neonatal resuscitation guidelines significantly improved, although there were no differences in secondary clinical outcome parameters.
We have successfully implemented a neonatal in situ simulation training programme. The observed improvement in one teamwork event category in the post-training period demonstrates the effectiveness of the training curriculum, while also showing the potential of in situ simulation training for improving postnatal care and, ultimately, patient outcome.
• In situ simulation-based training is conducted in the real healthcare environment, thus promoting experiential learning which is closely aligned with providers' actual work. • In situ simulation-based training may offer an additional benefit for patient outcomes in comparison to other instructional methodologies.
• This observational study investigated translational patient outcomes in preterm neonates before and after delivery of high-frequency in situ simulation-based training at a level IV neonatal intensive care unit. • There was a significant increase in the frequency of one major teamwork event following the delivery of in situ simulation-based training, indicating a notable improvement in the non-technical skills domain, which is closely linked to actual team performance.
本研究旨在评估四级新生儿重症监护病房（NICU）中基于现场模拟的培训对患者护理质量指标的影响。在格拉茨医科大学新生儿科进行了一项前后非对照的质量改进研究。教育干预包括 4 个月的时间，以结构化的现场模拟培训定期为新生儿提供者和护士提供，以跨专业团队的形式进行。主要研究结果是实际出生后稳定和复苏期间非技术技能和团队互动的质量。这是通过在教育干预前（培训前）和后（培训后）的两个 2 个月观察阶段期间的视频记录来评估的。使用麻醉师非技术技能（ANTS）评分，由两名外部、盲目的新生儿科医生评估产房视频记录。此外，我们还从培训前和培训后的视频记录中收集了视频记录中新生儿的临床患者数据，使用培训前和培训后的问卷评估了培训参与者对新生儿复苏指南的个人知识。共有 48 名医疗保健专业人员参加了 41 次现场模拟培训。在培训前，非技术技能和团队互动的水平已经很高，之后并没有进一步提高。尽管如此，我们观察到团队合作事件“评估计划”的显著增加（0.5 [IQR 0.0-1.0] 与 1.0 [1.0-2.0]，p=0.049）。教育干预后，培训参与者对新生儿复苏指南的知识显著提高，尽管次要临床结局参数没有差异。
我们已经成功实施了新生儿现场模拟培训计划。在培训后观察到的一个团队合作事件类别的改善表明了培训课程的有效性，同时也展示了现场模拟培训在提高出生后护理和最终改善患者结局方面的潜力。
·现场模拟培训是在实际医疗环境中进行的，因此促进了与提供者实际工作密切相关的体验式学习。
·与其他教学方法相比，现场模拟培训可能为患者结局提供额外的益处。
·本观察性研究在四级 NICU 中进行现场模拟培训前后，调查了早产儿的翻译患者结局。
·现场模拟培训后，一个主要团队合作事件的发生频率显著增加，表明非技术技能领域有了显著改善，这与实际团队表现密切相关。
