Teaching teamwork during the Neonatal Resuscitation Program: a randomized trial

Teaching team competencies within resuscitation training: A systematic review

Objectives

To evaluate the effectiveness of life support training with specific emphasis on team competencies on clinical and educational outcomes.

Methods

This systematic review was prospectively registered (PROSPERO CRD42023473154) and followed the PICOST (population, intervention, comparison, outcome, study design, timeframe) format. All randomized controlled trials and non-randomized studies evaluating learners undertaking life support training with specific emphasis on team competencies in any setting (actual and simulated resuscitations) were included. Unpublished studies were excluded. Medline, Embase and Cochrane databases as well as trial registries were searched from inception to August 2023 (updated January 18, 2024). Two researchers performed title and abstract screening, full-text screening, data extraction, assessment of risk of bias (using RoB2 and ROBINS-I) and certainty of evidence (using GRADE). PRISMA reporting checklist was used to report the results. No funding was obtained to perform this systematic review.

Results

The literature search identified 5470 manuscripts. After the removal of 2073 duplicates, reviewing the remaining articles' titles and abstracts yielded 31 articles for full-text review. Of these, 17 studies were finally included. The studies involved the following training levels: basic life support, adult advanced life support, paediatric and neonatal resuscitations. Most studies (n = 16) evaluated outcomes in simulated, and only one study in actual resuscitations. Studies included in all training contexts showed either neutrality and/or benefits of life support training with specific emphasis on team competencies. Team competencies training improved CPR skill performance and CPR quality. Specific team competencies that improved included leadership, communication, decision-making and task management. No undesirable effects were observed. Meta-analysis was not possible due to significant methodological heterogeneity. Sub-group analysis was impossible due to lack of data. Risk of bias assessment ranged from some concerns to serious. Overall certainty of evidence was rated as low to very low due to risk of bias and imprecision.

Conclusion

This systematic review identified very low and low certainty evidence, almost entirely derived from simulation studies. The studies and their findings were heterogenous but suggest that teaching team competencies can improve resuscitation skills performance and CPR quality, as well as improve team competencies, specifically leadership, communication, decision-making, and task management. Further research is required to understand optimal configuration of team competencies training interventions and to understand the effect on clinical outcomes and cost-effectiveness.

Effectiveness of simulation-based interprofessional education on teamwork and communication skills in neonatal resuscitation

BACKGROUND

The role of effective interprofessional teamwork is especially vital in the Neonatal Intensive Care Unit (NICU) where infants facing emergency situations are admitted. Proper neonatal resuscitation, facilitated by comprehensive resuscitation training, can significantly decrease the mortality rates associated with neonatal asphyxia and respiratory failure. This study aimed to develop a simulation-based interprofessional education (IPE) programme for medical staff working in a nursery and NICU and to assess its effectiveness on teamwork, communication skills, clinical performance, clinical judgement, interprofessional attitudes, and education satisfaction.

METHODS

Through a demand survey, neonatal resuscitation was selected as the theme, and an IPE team comprised of one doctor and two nurses was formed. The education programme consisted of three sessions lasting a total of 140 min: two simulation exercises and one theoretical education session. Data were collected from 18 nurses working in the nursery and NICU and 9 doctors working in the paediatrics department.

RESULTS

A comparison of the metrics before and after applying simulation-based IPE programmes revealed teamwork (Z=-2.67, p = .008), communication skills (Z=-2.68, p = .007), clinical performance (Z=-2.52, p = .012), clinical judgement (Z=-4.52, p < .001), and interprofessional attitude (Z=-3.64, p < .001) to have significantly improved. Education satisfaction scores were 4.73 points on average out of a maximum of 5. The simulation-based IPE programme was effective in improving the teamwork, communication, and clinical performance of resuscitation teams, individual clinical judgement, and interprofessional attitude.

CONCLUSIONS

Simulation-based IPE is effective for enhancing teamwork, team communication, clinical judgement skills, and clinical performance in neonatal resuscitation. This programme has the potential to contribute to the improvement of patient safety and the quality of neonatal care. Additional studies are needed to longitudinally examine the effects of the programme on patient safety and quality of neonatal care.

Enhancing team success in the neonatal intensive care unit: challenges and opportunities for fluid teams

Fluid teams, characterized by frequent changes in team membership, are vital in the neonatal intensive care unit (NICU) due to high patient acuity and the need for a wide range of specialized providers. However, many challenges can hinder effective teamwork in this setting. This article reviews the challenges related to fluid teamwork in the NICU and discusses recommendations from team science to address each challenge. Drawing from the current literature, this paper outlines three challenges that can hinder fluid teamwork in the NICU: incorporating patient families, managing hierarchy among team members, and facilitating effective patient handoffs. The review concludes with recommendations for managing NICU teamwork differently using strategies from team science.

Simulation in a blended learning curriculum for neonatology

Blended learning is a learner-centered educational method that combines online and traditional face-to-face educational strategies. Simulation is a commonly utilized platform for experiential learning and an ideal component of a blended learning curriculum. This section describes blended learning, including its strengths and limitations, educational frameworks, uses within health professions education, best practices, and challenges. Also included is a brief introduction to simulation-based education, along with theoretical and real-world examples of how simulation may be integrated into a blended learning curriculum. Examples of blended learning in Neonatal-Perinatal Medicine, specifically within the Neonatal Resuscitation Program, procedural skills training, and the National Neonatology Curriculum, are reviewed.

Efficiency analysis by training sequence of high-fidelity simulation-based neonatal resuscitation program (NRP)

OBJECTIVE

This study was conducted to find a more effective education method in a neonatal resuscitation program (NRP) using a high-fidelity simulation that has recently shown positive results in terms of its effectiveness.

STUDY DESIGN

A single-blind prospective cohort study was performed. The high-fidelity simulation model was used in a formal NRP training course for trainees caring for neonatal patients. The trainees were divided into a group that conducted the scenario after the lecture (Group A) and a group that attended the lecture after the scenario (Group B) and they both took the test before, during, and after the training.

RESULTS

The increase in score after theory training was statistically significant in both groups, but the final score did not differ between the two groups. However, when compared by career, in Group A, trainees under 24 months tended to be more effective, and in Group B, trainees over 24 months tended to be more effective.

CONCLUSION

The difference in short-term memory of trainees according to the order of education identified by the test score was not prominent, but it was found that the degree of difference in test scores for the order of education tended to be different according to the career. It is thought that the effectiveness of the training might be increased by changing the education order according to the degree of experience of each trainee. More effective educational methods should be introduced by continuously developing lectures for repeated education of various trainees in the future.

Defining the Epidemiology of Safety Risks in Neonatal Intensive Care Unit Patients Requiring Surgery

OBJECTIVE

The aim of the study was to determine the incidence, type, severity, preventability, and contributing factors of nonroutine events (NREs)-events perceived by care providers or skilled observers as a deviations from optimal care based on the clinical situation-in the perioperative (i.e., preoperative, operative, and postoperative) care of surgical neonates in the neonatal intensive care unit and operating room.

METHODS

A prospective observational study of noncardiac surgical neonates, who received preoperative and postoperative neonatal intensive care unit care, was conducted at an urban academic children's hospital between November 1, 2016, and March 31, 2018. One hundred twenty-nine surgical cases in 109 neonates were observed. The incidence and description of NREs were collected via structured researcher-administered survey tool of involved clinicians. Primary measurements included clinicians' ratings of NRE severity and contributory factors and trained research assistants' ratings of preventability.

RESULTS

One or more NREs were reported in 101 (78%) of 129 observed cases for 247 total NREs. Clinicians reported 2 (2) (median, interquartile range) NREs per NRE case with a maximum severity of 3 (1) (possible range = 1-5). Trained research assistants rated 47% of NREs as preventable and 11% as severe and preventable. The relative risks for National Surgical Quality Improvement Program - pediatric major morbidity and 30-day mortality were 1.17 (95% confidence interval = 0.92-1.48) and 1.04 (95% confidence interval = 1.00-1.08) in NRE cases versus non-NRE cases.

CONCLUSIONS

The incidence of NREs in neonatal perioperative care at an academic children's hospital was high and of variable severity with a myriad of contributory factors.

Video recording in the delivery room: current status, implications and implementation

Many factors determine the performance and success of delivery room management of newborn babies. Improving the quality of care in this challenging surrounding has an important impact on patient safety and on perinatal morbidity and mortality. Video recording (VR) offers the advantage to record and store work as done rather than work as recalled. It provides information about adherence to algorithms and guidelines, and technical, cognitive and behavioural skills. VR is feasible for education and training, improves team performance and results of research led to changes of international guidelines. However, studies thus far have not provided data regarding whether delivery room video recording affects long-term team performance or clinical outcomes. Privacy is a concern because data can be stored and individuals can be identified. We describe the current state of clinical practice in high- and low-resource settings, discuss ethical and medical-legal issues and give recommendations for implementation with the aim of improving the quality of care and outcome of vulnerable babies. IMPACT: VR improves performance by health caregivers providing neonatal resuscitation, teaching and research related to delivery room management, both in high as well low resource settings. VR enables information about adherence to guidelines, technical, behavioural and communication skills within the resuscitation team. VR has ethical and medical-legal implications for healthcare, especially recommendations for implementation of VR in routine clinical care in the delivery room. VR will increase the awareness that short- and long-term outcomes of babies depend on the quality of care in the delivery room.

A Novel Code Team Leader Card to Improve Leader Identification

Prompt and clear code team leader identification is vital in effective cardiopulmonary resuscitation (CPR), and pediatric trainees often have limited experience in these scenarios. This project sought to develop a tangible object that provided clear leader identification and assisted in code team management and simulated team training. A Code Team Leader Card (CTLC) was designed to provide clear leader identification while simultaneously providing a cognitive aid via integration of pediatric advanced life support (PALS) algorithms. Additionally, CTLC served to occupy the leader's hands to limit their ability to intervene on procedural tasks. The CTLC was incorporated into pediatric resident simulation training, and pre- and postintervention survey data were analyzed. Analysis particularly focused on whether "a leader was clearly identified by all team members." The relationship between CTLC implementation and consistent leader recognition was evaluated using chi-squared test, and secondary qualitative data were obtained via debriefing sessions. Pediatric residents completed 131 surveys prior to CTLC implementation and 41 surveys after implementation. Consistent code team leader recognition increased significantly from 61.8% (81 of 131) pre-CTLC to 80.5% (33 of 41) after introduction of CTLC (P=0.027). Participants commented on the benefits of CTLC during debriefing sessions. Use of a CTLC significantly improved leader recognition during simulated CPR. Inclusion of PALS algorithms led to normalization and increased utilization of these adjunct materials. The CTLC provided a secondary benefit of occupying the leader's hands, thereby allowing that person to focus on overseeing the team rather than assisting with procedural tasks.

Pediatric rapid response system innovations

Rapid Response Systems (RRSs) are an organizational approach to support the timely recognition and treatment of decompensating patients and are used in many pediatric hospitals. These systems are comprised of afferent and efferent Limbs, as well as oversight arms. When incorporated into an RRS, standardized care algorithms can be helpful in identifying deteriorating patients and improving behaviors of the multidisciplinary team. The aim of this paper is to provide an overview of pediatric RRS and provide an example in which standardized care algorithms developed for the efferent limb of a pediatric RRS were associated with improvement in early escalation of care.PLAIN LANGUAGE SUMMARYThe Rapid Response System (RRS) is used in hospitals to recognize and care for hospitalized patients that are decompensating outside of an Intensive Care Unit. RRSs are made up of two main response components. The afferent limb focuses on the recognition and calls for help; the efferent limb focuses on correcting the deteriorating patient's physiology. Much energy has been put into afferent limb development to identify worsening patients before they progress to full cardiac or respiratory arrest. Standardization of efferent limb care algorithms can assist in developing and maintaining a shared mental model of care to improve communication and function of the multidisciplinary team.

Surgical Team Familiarity: An Integrative Review

The dynamic nature of perioperative care often brings unfamiliar clinicians together yet requires them to collectively provide complex health care in a challenging environment. In this review, we comprehensively evaluated evidence regarding surgical team familiarity and its relationship to surgical team performance. Using a comprehensive and iterative search strategy, we searched PubMed, Web of Science, PsycInfo, and EMBASE for surgical team familiarity manuscripts. We identified 598 manuscripts, 16 of which met our inclusion criteria. We found that surgical team familiarity is associated with improved performance for many metrics, including shorter total operative time, team member safety, decreased surgical errors and disruptions, reduced miscommunication, and fewer patient readmissions. Although additional research would be helpful, surgical managers should consider team familiarity and consistency in team membership when assigning staff members to surgical teams to optimize surgical care, decrease inefficiencies, and promote safe patient outcomes.

Impact of Task-Oriented Role Assignment on Neonatal Resuscitation Performance: A Simulation-Based Randomized Controlled Trial

OBJECTIVE

Task-oriented role assignment (TORA) is the assignment of a specific role, a list of tasks, and a location to stand to each resuscitation team member. We performed this study to examine the impact of TORA training during a Neonatal Resuscitation Program (NRP) course on neonatal resuscitation team technical performance and behavioral skills.

STUDY DESIGN

Participants were cluster randomized into either a standard NRP course (control) or an NRP course with TORA training. Both technical and behavioral skills were evaluated using standardized simulations. The simulations were video recorded and then scored by two blinded reviewers using previously validated instruments.

RESULTS

A total of 65 participants (62 resident physicians and 3 nurses) participated in 108 simulations (48 controls, 60 TORA). Technical skill scores were similar between the two groups (control = 77.6% [±8.4] vs. TORA = 78.1% [±8.1]; p = 0.74). The TORA group had higher behavior skill scores in 8 of the 10 NRP key behavioral skills and had higher overall behavioral skill scores (control = 30.1 [±7.2] vs. TORA = 34.9 [±4.8]; p < 0.001).

CONCLUSION

In resuscitation teams comprising mostly resident physicians, TORA training resulted in better behavioral skills during simulated neonatal resuscitation. Further study on the impact of TORA training on actual resuscitation performance in interdisciplinary teams is warranted.

The Effect of Teaching Nontechnical Skills in Advanced Life Support: A Systematic Review

OBJECTIVES

The objective of this study was to evaluate the effect of nontechnical skills (NTS) training on performance in advanced life support (ALS) simulation. Furthermore, we aimed to determine the ideal frequency of training sessions for an optimal retention and the value of debriefing.

METHODS

A systematic search was performed using PubMed, EMBASE, WoS, ERIC, CINAHL, and the Cochrane Library conducted through August 1, 2018. All primary studies mentioning NTS in ALS education were included. Three reviewers independently extracted data on study design and outcome. The MERSQI approach was used to evaluate the overall quality of evidence.

RESULTS

Of the 10,723 identified articles, 40 studies were included with a combined total of 3,041 participants, ranging from students to experts. Depending on the focus of the study, articles were categorized in NTS (n = 25), retention (n = 8), and feedback (n = 10). Incorporating NTS during ALS simulation showed significant improvements in timing for performing critical first steps. Furthermore, good leadership skills had a favorable effect on overall technical performance and teamwork during simulation improved team dynamics and performance. Finally, debriefing also had a beneficial effect on team performance. One particular type of debriefing does not appear to be superior to other types of debriefing.

CONCLUSION

Team simulation training resulted in improved NTS and a reduction in the time required to complete a simulated cardiac arrest. Therefore, a formal NTS program should be introduced into ALS courses. Feedback and repetitive practice are key factors to train NTS. The impact of training on team behaviors can persist for at least 3 to 6 months. In conclusion, understanding and improving NTS may help to create more effective teams. The effect on patient outcome requires further investigation.

Effectiveness of surgical residents compared to surgical faculty in teaching trauma evaluation and management

Introduction

Senior medical students learn trauma principles in a 90-min interactive teaching session based on the trauma evaluation and management module designed by the American College of Surgeons. However, the number of surgical faculty available to conduct these interactive small group sessions is limited. The goal of this study is to compare the effectiveness of surgical residents to that of surgical faculty in teaching trauma principles.

Methods

53 senior medical students received trauma teaching from trauma faculty ( n = 22), trauma residents ( n = 21), or no teaching ( n = 10). Students were tested on cognitive trauma knowledge (20 multiple choice questions) and clinical trauma simulation (using objective structured clinical performance score). All students completed a 5-point subjective questionnaire.

Results

Students receiving trauma teaching outperformed students receiving no teaching in the knowledge test (mean 13.0 ± 3.6 standard deviation (SD) vs. 8.4 ± 2.4 SD, p < 0.05), while faculty and resident teaching outcomes were similar (mean 12.6 ± 3.0 SD vs. 13.4 ± 4.1, p = 0.45). Similarly, in the clinical trauma simulation, students receiving trauma teaching scored better (objective score mean 78% vs. 56%, p < 0.05), while there was no difference between faculty and resident teaching outcomes (objective score mean 77% vs. 80%, p = 0.52). In the subjective questionnaire, students who received trauma teaching rated themselves higher on a scale of 10 in trauma knowledge and skills than those who did not have formal teaching (mean 5.2 vs. 2.1, p < 0.05) as resident and attending teaching group ratings were similar.

Conclusions

Although small group discussions and increased simulation enhance undergraduate surgical trauma education, the number of faculty surgeons needed to fully incorporate these activities is limited. Objective and perceived effectiveness of teaching trauma management by surgical residents compared to trauma attendings is equivalent. This highlights the opportunity to incorporate residents into teaching roles to bridge the gap in undergraduate trauma education.

Assessment of Patient Safety Culture in a Pediatric Department

Background An assessment of the prevalent culture needs to be the first step when building patient safety programs in healthcare organizations to achieve high-quality health care. Objective To conduct a baseline assessment of patient safety culture, to provide insight into the factors that contribute to patient safety, and to use the information to make improvements.  Methods The Hospital Survey on Patient Safety Culture (PSC) questionnaire was conducted from October through December 2020 at the Brookdale Hospital Medical Center (BHMC) Pediatric departments (Pediatric Inpatient Unit, Neonatal Intensive Care Unit [NICU], Pediatric Intensive Care Unit [PICU], and Pediatric Emergency Department) and four community-based ambulatory pediatric practices (Brookdale Family Care Centers [BFCC]). The percentages of positive responses on the 12 patient-safety dimensions and the summation of PSC and two outcomes (overall patient safety grade and adverse events reported in the past year) were assessed. Factors associated with PSC aggregate score were analyzed. Results From the 385 emails that were sent, 136 surveys were considered for analysis. This gives us a response rate of 35.3%. Most of the participants were nurses (58%) with direct contact with patients (94.2%). Most respondents did not report any events (60.7%), whereas 30.3% reported 1-2 events in the past year. The patient safety composites with the highest positive scores were teamwork within units (78%), supervisor/manager expectations and actions promoting patient safety (71.2%), and organizational learning--continuous improvement (66.8%). The composites with the lowest scores were non-punitive response to error (35.9%) and staffing (38%). Conclusions All of our composite measures, with the exception of teamwork within units, appear to be low, which means that all the other composite measures require interventions for improvement of overall safety culture. In order for healthcare leaders and policymakers to establish a culture of safety and improvement, they must create a climate of open communication, continuous learning, and eliminate the fear of blame and punitive feedback.

European Resuscitation Council Guidelines 2021: Newborn resuscitation and support of transition of infants at birth

The European Resuscitation Council has produced these newborn life support guidelines, which are based on the International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support. The guidelines cover the management of the term and preterm infant. The topics covered include an algorithm to aid a logical approach to resuscitation of the newborn, factors before delivery, training and education, thermal control, management of the umbilical cord after birth, initial assessment and categorisation of the newborn infant, airway and breathing and circulation support, communication with parents, considerations when withholding and discontinuing support.

Teamwork, communication and resident leadership at resident-attended, neonatal delivery room resuscitations

OBJECTIVE

Determine if a NICU resident delivery room (DR) skills educational curriculum is associated with changes in neonatal resuscitation team characteristics, including teamwork, communication and leadership.

STUDY DESIGN

This prospective, observational study of resident-attended neonatal resuscitations utilized team questionnaire, video assessment and chart review. Each resident NICU block included a curriculum consisting of two educational programs focusing on NRP knowledge and skills with additional emphasis on teamwork and communication strategies.

RESULTS

Ninety-nine resuscitations met inclusion criteria. Comparing behaviors at the beginning versus end of a NICU block, residents demonstrated increased frequency of initiating leadership (31% vs. 93%, p < 0.001) and maintaining leadership (19% vs. 79%, p < 0.001) at low-risk, resident-attended DR resuscitations. Overall measurements of teamwork and communication were unchanged.

CONCLUSIONS

A NICU DR skills educational curriculum is associated with increased resident leadership at low-risk DR resuscitations over the course of NICU blocks, without compromising measurements of teamwork or communication.

The effect of team and leadership training of advanced life support providers on patient outcomes: A systematic review

AIM

To conduct a systematic review evaluating improvement in team and leadership performance and resuscitation outcomes after such a training of healthcare providers during advanced life support (ALS) courses.

METHODS

This systematic review asked the question of whether students taking structured and standardised ALS courses in an educational setting which include specific leadership or team training, compared to no such specific training in these courses, improves patient survival, skill performance in actual resuscitations, skill performance at 3-15 months (patient tasks, teamwork, leadership), skill performance at course conclusion (patient tasks, teamwork, leadership), or cognitive knowledge PubMed, Embase and the Cochrane database were searched until April 2020. Screening of articles, analysis of risk of bias, outcomes and quality assessment were performed according to the Grading of Recommendations Assessment, Development and Evaluation methodology. Only studies with abstracts in English were included.

RESULTS

14 non-randomised studies and 17 randomised controlled trials, both in adults and children, and seven studies involving patients were included in this systematic review. No randomised controlled trials but three observational studies of team and leadership training showed improvement in the critical outcome of "patient survival". However, they suffered from risk of bias (indirectness and imprecision). The included studies reported many different methods to teach leadership skills and team behaviour.

CONCLUSION

This systematic review found very low certainty evidence that team and leadership training as part of ALS courses improved patient outcome. This supports the inclusion of team and leadership training in ALS courses for healthcare providers.

Lessons Learned from a Collaborative to Develop a Sustainable Simulation-Based Training Program in Neonatal Resuscitation: Simulating Success

Newborn resuscitation requires a multidisciplinary team effort to deliver safe, effective and efficient care. California Perinatal Quality Care Collaborative’s Simulating Success program was designed to help hospitals implement on-site simulation-based neonatal resuscitation training programs. Partnering with the Center for Advanced Pediatric and Perinatal Education at Stanford, Simulating Success engaged hospitals over a 15 month period, including three months of preparatory training and 12 months of implementation. The experience of the first cohort (Children’s Hospital of Orange County (CHOC), Sharp Mary Birch Hospital for Women and Newborns (SMB) and Valley Children’s Hospital (VCH)), with their site-specific needs and aims, showed that a multidisciplinary approach with a sound understanding of simulation methodology can lead to a dynamic simulation program. All sites increased staff participation. CHOC reduced latent safety threats measured during team exercises from 4.5 to two per simulation while improving debriefing skills. SMB achieved 100% staff participation by identifying unit-specific hurdles within in situ simulation. VCH improved staff confidence level in responding to neonatal codes and proved feasibility of expanding simulation across their hospital system. A multidisciplinary approach to quality improvement in neonatal resuscitation fosters engagement, enables focus on patient safety rather than individual performance, and leads to identification of system issues.

[Newborn resuscitation and support of transition of infants at birth]

The European Resuscitation Council has produced these newborn life support guidelines, which are based on the International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support. The guidelines cover the management of the term and preterm infant. The topics covered include an algorithm to aid a logical approach to resuscitation of the newborn, factors before delivery, training and education, thermal control, management of the umbilical cord after birth, initial assessment and categorisation of the newborn infant, airway and breathing and circulation support, communication with parents, considerations when withholding and discontinuing support.

A Human Factors Approach to Surgical Patient Safety

This article explores the role of human factors engineering in patient safety in surgery. The authors discuss the history and evolution of human factors and the role of human factors in patient safety and provide a description of human factors methods used to study and improve patient safety.

Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.

Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.

Effect of Computer Debriefing on Acquisition and Retention of Learning After Screen-Based Simulation of Neonatal Resuscitation: Randomized Controlled Trial

Background

Debriefing is key in a simulation learning process.

Objective

This study focuses on the impact of computer debriefing on learning acquisition and retention after a screen-based simulation training on neonatal resuscitation designed for midwifery students.

Methods

Midwifery students participated in 2 screen-based simulation sessions, separated by 2 months, session 1 and session 2. They were randomized in 2 groups. Participants of the debriefing group underwent a computer debriefing focusing on technical skills and nontechnical skills at the end of each scenario, while the control group received no debriefing. In session 1, students participated in 2 scenarios of screen-based simulation on neonatal resuscitation. During session 2, the students participated in a third scenario. The 3 scenarios had an increasing level of difficulty, with the first representing the baseline level. Assessments included a knowledge questionnaire on neonatal resuscitation, a self-efficacy rating, and expert evaluation of technical skills as per the Neonatal Resuscitation Performance Evaluation (NRPE) score and of nontechnical skills as per the Anaesthetists’ Non-Technical Skills (ANTS) system. We compared the results of the groups using the Mann-Whitney U test.

Results

A total of 28 midwifery students participated in the study. The participants from the debriefing group reached higher ANTS scores than those from the control group during session 1 (13.25 vs 9; U=47.5; P=.02). Their scores remained higher, without statistical difference during session 2 (10 vs 7.75; P=.08). The debriefing group had higher self-efficacy ratings at session 2 (3 vs 2; U=52; P=.02). When comparing the knowledge questionnaires, the significant baseline difference (13 for debriefing group vs 14.5 for control group, P=.05) disappeared at the end of session 1 and in session 2. No difference was found for the assessment of technical skills between the groups or between sessions.

Conclusions

Computer debriefing seems to improve nontechnical skills, self-efficacy, and knowledge when compared to the absence of debriefing during a screen-based simulation. This study confirms the importance of debriefing after screen-based simulation.

Trial Registration

ClinicalTrials.gov NCT03844009; https://clinicaltrials.gov/ct2/show/NCT03844009

Educational Perspectives: Toward More Effective Neonatal Resuscitation: Assessing and Improving Clinical Skills

Newborn deaths following birth asphyxia remain a significant global problem, and effective resuscitation by well-trained professionals may reduce mortality and morbidity. Clinicians are often responsible for teaching newborn resuscitation to trainees. Multiple educational methods are used to teach these skills, but data supporting their efficacy are limited. Mask ventilation and chest compressions are considered the basics of resuscitation. These technical motor skills are critically important but difficult to teach and often not objectively assessed. Teaching more advanced skills such as neonatal intubation is challenging, because teaching opportunities and working hours of learners have declined. Videolaryngoscopy appears to be an effective teaching tool that allows instruction during clinical practice. There is also emerging recognition that effective resuscitation requires more than individual clinical skills. The importance of teamwork and leadership is now recognized, and teamwork training should be incorporated because it improves these nontechnical skills. Simulation training has become increasingly popular as a method of teaching both technical and nontechnical skills. However, there are unanswered questions about the validity, fidelity, and content of simulation. Formal resuscitation programs usually incorporate a mixture of teaching modalities and appear to reduce neonatal mortality and morbidity in low- and middle-income countries. Emerging teaching techniques such as tele-education, video debriefing, and high-frequency training warrant further investigation.

A systematic review exploring the content and outcomes of interventions to improve psychological safety, speaking up and voice behaviour

Background

Having psychologically safe teams can improve learning, creativity and performance within organisations. Within a healthcare context, psychological safety supports patient safety by enabling engagement in quality improvement and encouraging staff to speak up about errors. Despite the low levels of psychological safety in healthcare teams and the important role it plays in supporting patient safety, there is a dearth of research on interventions that can be used to improve psychological safety or its related constructs. This review synthesises the content, theoretical underpinnings and outcomes of interventions which have targeted psychological safety, speaking up, and voice behaviour within a healthcare setting. It aims to identify successful interventions and inform the development of more effective interventions.

Methods

A key word search strategy was developed and used to search electronic databases (PsycINFO, ABI/Inform, Academic search complete and PubMed) and grey literature databases (OpenGrey, OCLC WorldCat, Espace). Covidence, an online specialised systematic review website, was used to screen records. Data extraction, quality appraisal and narrative synthesis were conducted on identified papers.

Results

Fourteen interventions were reviewed. These interventions fell into five categories. Educational interventions used simulation, video presentations, case studies and workshops while interventions which did not include an educational component used holistic facilitation, forum play and action research meetings. Mixed results were found for the efficacy or effectiveness of these interventions. While some interventions showed improvement in outcomes related to psychological safety, speaking up and voice, this was not consistently demonstrated across interventions. Included interventions’ ability to demonstrate improvements in these outcomes were limited by a lack of objective outcome measures and the ability of educational interventions alone to change deeply rooted speaking up behaviours.

Conclusion

To improve our understanding of the efficacy or effectiveness of interventions targeting psychological safety, speaking up and voice behaviour, longitudinal and multifaceted interventions are needed. In order to understand whether these interventions are successful, more objective measures should be developed. It is recommended that future research involves end users in the design phase of interventions, target both group and organisational levels, ensure visible leader support and work across and within interdisciplinary teams.

Prospero registration number

CRD42018100659.

Simulation in Neonatal Resuscitation

Approximately 1 in 10 newborns will require basic resuscitation interventions at birth. Some infants progress to require more advanced measures including the provision of positive pressure ventilation, chest compressions, intubation and administration of volume/cardiac medications. Although advanced resuscitation is infrequent, it is crucial that personnel adequately trained in these techniques are available to provide such resuscitative measures. In 2000, Louis Halmalek et al. called for a "New Paradigm in Pediatric Medical Education: Teaching Neonatal Resuscitation in a Simulated Delivery Room Environment." This was one of the first articles to highlight simulation as a method of teaching newborn resuscitation. The last decades have seen an exponential growth in the area of simulation in newborn care, in particular in newborn resuscitation and stabilization. Simulation is best defined as an instructional strategy "used to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner." Simulation training has now become an important point of how we structure training and deliver improved healthcare to patients. Some of the key aspects of simulation training include feedback, deliberate practice, outcome measurement, retention of skills and curriculum integration. The term "Train to win" is often used in sporting parlance to define how great teams succeed. The major difference between sports teams is that generally their game day comes once a week, whereas in newborn resuscitation every day is potentially "game day." In this review we aim to summarize the current evidence on the use of simulation based education and training in neonatal resuscitation, with particular emphasis on the evidence supporting its effectiveness. We will also highlight recent advances in the development of simulation based medical education in the context of newborn resuscitation to ensure we "train to win."

Nursing Surveillance for Deterioration in Pediatric Patients: An Integrative Review

PROBLEM

Adverse events occur in up to 19% of pediatric hospitalized patients, often associated with delays in recognition or treatment. While early detection is recognized as a primary determinant of recovery from deterioration, most research has focused on profiling patient risk and testing interventions, and less on factors that impact surveillance efficacy. This integrative review explored actions and factors that influence the quality of pediatric nursing surveillance.

ELIGIBILITY CRITERIA

Original research on nursing surveillance, escalation of care, or cardiopulmonary deterioration in hospitalized pediatric patients in non-critical environments, published in English in peer reviewed journals.

SAMPLE

Twenty-four studies from a literature search within the databases of CINAHL, PubMed, and Web of Science were evaluated and synthesized using a socio-technical systems theory framework. Study quality was assessed using The Mixed Methods Appraisal Tool.

RESULTS

Assessment, documentation, decision-making, intervening and communicating were identified as activities associated with surveillance of deterioration. Factors that influenced nurses' detection of deterioration were patient acuity, nurse education, experience, expertise and confidence, staffing, standardized assessment and communication tools, availability of emergency services, team composition and opportunities for multidisciplinary care planning.

CONCLUSIONS

Research provides insight into some aspects of nursing surveillance but does not adequately explore factors that affect clinical data interpretation and synthesis, and role integration between nurse and parents, and nurse and other clinicians on surveillance of clinical stability.

IMPLICATIONS

Research is needed to enhance understanding of the contextual factors that impact nursing surveillance to inform intervention design to support nurses' timely recognition and mitigation of clinical deterioration.

The role of human factors in neonatal patient safety

The relationship between the fields of human factors and patient safety is relatively nascent but represents a powerful interaction that has developed in only the last twenty years. Application of human factors principles, techniques, and science can facilitate the development of healthcare systems, protocols, and technology that leverage the enormous and adaptable capacity of human performance while acknowledging human vulnerability and decreasing the risk of error during patient care. This chapter will review these concepts and employ case studies from neonatal care to demonstrate how an understanding of human factors can be applied to improve patient safety.

Improving the position of resuscitation team leader with simulation (IMPORTS); a pilot cross-sectional randomized intervention study

BACKGROUND

Leadership and teamwork are important contributory factors in determining cardiac resuscitation performance and clinical outcome. We aimed to determine whether fixed positioning of the resuscitation team leader (RTL) relative to the patient influences leadership qualities during cardiac resuscitation using simulation.

METHODS

A cross-sectional randomized intervention study over 12 months' duration was conducted in university hospital simulation lab. ACLS-certified medical doctors were assigned to run 2 standardized simulated resuscitation code as RTL from a head-end position (HEP) and leg-end position (LEP). They were evaluated on leadership qualities including situational attentiveness (SA), errors detection (ED), and decision making (DM) using a standardized validated resuscitation-code-checklist (RCC). Performance was assessed live by 2 independent raters and was simultaneously recorded. RTL self-perceived performance was compared to measured performance.

RESULTS

Thirty-four participants completed the study. Mean marks for SA were 3.74 (SD ± 0.96) at HEP and 3.54 (SD ± 0.92) at LEP, P = .48. Mean marks for ED were 2.43 (SD ± 1.24) at HEP and 2.21 (SD ± 1.14) at LEP, P = .40. Mean marks for DM were 4.53 (SD ± 0.98) at HEP and 4.47 (SD ± 0.73) at LEP, P = .70. The mean total marks were 10.69 (SD ± 1.82) versus 10.22 (SD ± 1.93) at HEP and LEP respectively, P = .29 which shows no significance difference in all parameters. Twenty-four participants (71%) preferred LEP for the following reasons, better visualization (75% of participants); more room for movement (12.5% of participants); and better communication (12.5% of participants). RTL's perceived performance did not correlate with actual performance CONCLUSION:: The physical position either HEP or LEP appears to have no influence on performance of RTL in simulated cardiac resuscitation. RTL should be aware of the advantages and limitations of each position.

Using video to assess and improve patient safety during simulated and actual neonatal resuscitation

Neonatal resuscitation is an event that can cause high stress among healthcare professionals (HCPs) and is frequently associated with medical errors. Improving patient safety and reducing errors requires a concerted effort with a plan for improvement. Video can be used as a component of the improvement process at several points including standardizing educational information, assessing learner knowledge and skills during simulation, and assessing individual and team performance during actual neonatal resuscitations.

Basic life support training using shared mental models improves team performance of first responders on normal wards: A randomised controlled simulation trial

INTRODUCTION

Survival of in-hospital cardiac arrest (IHCA) depends on fast and effective action of the first responding team. Not only technical skills, but professional teamwork is required. Observational studies and theoretical models suggest that shared mental models of members improve teamwork. This study investigated if a training on shared mental models, improves team performance in simulated in-hospital cardiac arrest.

METHODS

On the background of an introduction of mandatory Basic Life Support (BLS) training for clinical staff a randomized controlled trial was performed to compare two training methods. Staff from clinical departments was randomised to receive either a conventional instructor led training (control group) or an interventional training (intervention group). The interventional training was based on self-directed learning of the group in order to develop shared mental models. Primary outcome were mean scores of the team assessment scale (TAS) and the hands-off time. Secondary outcome were mean scores for quality of BLS.

RESULTS

Performance of 75 teams of the interventional and 66 of the control group was analysed. The hands-off time was significantly lower in the interventional group (5.42% vs. 8.85%, p = 0.029). Scores of the TAS and the overall BLS score were high and not significantly different between the groups. Hands-off time correlated significantly negative with all TAS items.

CONCLUSION

BLS training for clinical staff which creates shared mental models reduces hands-off time in a simulated cardiac arrest scenario. Training methods establishing shared mental models of team members can be considered for effective team trainings without adding additional training time.

Observer-based tools for non-technical skills assessment in simulated and real clinical environments in healthcare: a systematic review

Background

Over the past three decades multiple tools have been developed for the assessment of non-technical skills (NTS) in healthcare. This study was designed primarily to analyse how they have been designed and tested but also to consider guidance on how to select them.

Objectives

To analyse the context of use, method of development, evidence of validity (including reliability) and usability of tools for the observer-based assessment of NTS in healthcare.

Design

Systematic review.

Data sources

Search of electronic resources, including PubMed, Embase, CINAHL, ERIC, PsycNet, Scopus, Google Scholar and Web of Science. Additional records identified through searching grey literature (OpenGrey, ProQuest, AHRQ, King’s Fund, Health Foundation).

Study selection

Studies of observer-based tools for NTS assessment in healthcare professionals (or undergraduates) were included if they: were available in English; published between January 1990 and March 2018; assessed two or more NTS; were designed for simulated or real clinical settings and had provided evidence of validity plus or minus usability. 11,101 articles were identified. After limits were applied, 576 were retrieved for evaluation and 118 articles included in this review.

Results

One hundred and eighteen studies describing 76 tools for assessment of NTS in healthcare met the eligibility criteria. There was substantial variation in the method of design of the tools and the extent of validity, and usability testing. There was considerable overlap in the skills assessed, and the contexts of use of the tools.

Conclusion

This study suggests a need for rationalisation and standardisation of the way we assess NTS in healthcare and greater consistency in how tools are developed and deployed.

Evaluating the impact of an assertiveness communication training programme for Japanese nursing students: A quasi-experimental study

AIM

To examine the impact of an assertiveness communication training programme on Japanese nursing students' level of assertiveness and intention to speak up when concerned about patient safety.

DESIGN

A quasi-experimental design with two parallel groups was used.

METHODS

Third-year nursing students from two Japanese educational institutions were allocated to an intervention and control group. The intervention group completed the Theory of Planned Behaviour-Assertive Communication Questionnaire and the Japanese version of the Rathus Assertiveness Schedule after attending assertive communication workshops. The second group completed the surveys before attending the workshop and were referred as the control group. Data were collected in December 2017-January 2018.

RESULTS

A total of 123 out of 150 nursing students completed the surveys. Following the assertiveness communication training programme, a higher percentage of students from the intervention group demonstrated the intention to speak up. The intervention group also displayed higher levels of assertiveness, although the results were not statistically significant.

A TeamSTEPPS® implementation plan for recently assigned interns and nurses

Interns and newly assigned nurses are expected to assimilate rapidly and begin functioning as members of interprofessional teams. This mixed-method pilot research assessed the impact of a Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) implementation plan in an urban academic teaching hospital that included a cohort of newly assigned pediatric interns and nurses (N = 23). We collected pre- and post-intervention course knowledge and team performance data from two teams in two separate simulation cases. We also surveyed the learners using an open-ended survey to ask about the value of their interprofessional learning experience. TeamSTEPPS® course knowledge improved from pre- to post-intervention (p < 0.001). Team performance scores were tallied and descriptively compared between pre- and post-intervention. Teams performed higher in both post-intervention simulation cases than in the pre-assessments. Post-intervention groups were assessed scores of 4 and 5 in more areas of the team performance checklist. Knowledge scores were compared between pre- and post- intervention by a Wilcoxon rank-sum test. Median scores improved from 17 to 20 following the intervention. Six themes emerged from the coding process that expressed a learned appreciation for contributing to a culture where the expectation is that team members speak up to support patient safety and other team members. As shown by this pilot research, TeamSTEPPS® training approaches that follow the 4-phase brain-based lesson plan for simulation and include interprofessional membership can be promising for integrating newly assigned members into existing clinical teams.

Evaluation of TEAM dynamics before and after remote simulation training utilizing CERTAIN platform

OBJECTIVE

The current study examines the feasibility and potential effects of long distance, remote simulation training on team dynamics.

DESIGN

The study design was a prospective study evaluating team dynamics before and after remote simulation.

SUBJECTS

Study subjects consisted of interdisciplinary teams (attending physicians, physicians in training, advanced care practitioners, and/or nurses).

SETTING

The study was conducted at nine training sites in eight countries.

INTERVENTIONS

Study subjects completed 2-3 simulation scenarios of acute crises before and after training with the Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN).

MEASUREMENTS AND MAIN RESULTS

Pre- and post-CERTAIN training simulations were evaluated by two independent reviewers utilizing the Team Emergency Assessment Measure (TEAM), which is a 11-item questionnaire that has been validated for assessing teamwork in the intensive care unit. Any discrepancies of greater than 1 point between the two reviewers on any question on the TEAM assessment were sent to a third reviewer to judge. The score that was deemed discordant by the third judge was eliminated. Pre- and post-CERTAIN training TEAM scores were averaged and compared. Of the nine teams evaluated, six teams demonstrated an overall improvement in global team performance following CERTAIN virtual training. For each of the 11 TEAM assessments, a trend toward improvement following CERTAIN training was noted; however, no assessment had universal improvement. 'Team composure and control' had the least absolute score improvement following CERTAIN training. The greatest improvement in the TEAM assessment scores was in the 'team's ability to complete tasks in a timely manner' and in the 'team leader's communication to the team'.

CONCLUSION

The assessment of team dynamics using long distance, virtual simulation training appears to be feasible and may result in improved team performance during simulated patient crises; however, language and video quality were the two largest barriers noted during the review process.

Effects of designated leadership and team-size on cardiopulmonary resuscitation: The Basel-Washington SIMulation (BaWaSim) trial

OBJECTIVE

During cardiopulmonary resuscitation (CPR), it remains unclear whether designating an individual person as team leader compared with emergent leadership results in better team performance. Also, the effect of CPR team size on team performance remains understudied.

METHODS

This randomized-controlled trial compared designated versus emergent leadership and size of rescue team (3 vs 6 rescuers) on resuscitation performance.

RESULTS

We included 90 teams with a total of 408 students. No difference in mean (±SD) hands-on time (seconds) were observed between emergent leadership (106 ± 30) compared to designated leadership (103 ± 27) groups (adjusted difference - 2.97 (95%CI -15.75 to 9.80, p = 0.645), or between smaller (103 ± 30) and larger teams (106 ± 26, adjusted difference 3.53, 95%CI -8.47 to 15.53, p = 0.56). Emergent leadership groups had a shorter time to circulation check and first defibrillation, but the quality of CPR based on arm and shoulder position was lower. No differences in CPR quality measures were observed between smaller and larger teams.

CONCLUSIONS

Within this international US/Swiss trial, leadership designation and larger team size did not improve hands-on time, but emergent leadership teams initiated defibrillation earlier. Improvements in performance may be more likely to be achieved by optimization of emergent leadership than increasing the size of cardiac arrest teams.

Rapid response systems for paediatrics: Suggestions for optimal organization and training

Resuscitation and cardiac arrest events in the paediatric population are rare occurrences. Improving outcomes from such events continues to be a difficult challenge. Rapid response systems and teams have been integrated into many hospitals in an effort to facilitate early identification and management of patients at risk for clinical deterioration. Optimizing education in the form of team training is a major component of successful team performance. Simulation-based team training, is a key educational supplement for existing standardized resuscitation courses. This position statement describes the evidence supporting rapid response systems and teams as well as simulation-based team training and provides recommendations for implementation in hospital care for paediatric patients.

Culture, silence and voice: The implications for patient safety in the operating theatre

Team culture is an important antecedent to safety behaviours such as speaking up. A positive safety culture in the operating theatre has been linked to fewer adverse events. Psychological safety, a component of safety culture, is the belief that the team is safe to take risks such as raising concerns. Power dynamics can influence active speaking up behaviour or 'voice'. When theatre team members chose to remain silent rather than voice concerns this can be a protective or defensive strategy rather than passive inactivity.

Evaluation of the Effect of a Clinical Pathway on the Quality of Simulated Pre-Hospital Cardiopulmonary Resuscitation: Primary Experience from a Chinese Pre-Hospital Care Centre

Objective

The aim of this study was to assess the quality of simulated cardiopulmonary resuscitation (CPR) in local pre-hospital care teams and the improvement achieved by using clinical pathways.

Methods

A prospective observation study. The 2010 American Heart Association Guidelines for CPR, the personnel characteristics of ambulance staff, China's legal system requirements, and the available medical resources were used to design a clinical pathway for pre-hospital care of cardiac arrest. Case simulations were used to evaluate the quality of CPR before and after implementation of the clinical pathway.

Results

The number of teams which successfully implemented electrocardiogram monitoring, endotracheal intubation and intravenous access before training were 8 (17.8%), 5 (11.1%) and 6 (13.3%) respectively. These increased to 45 (100%), 43 (95.6%) and 43 (95.6%), respectively, after training. The number of teams with successful implementation of artificial ventilation, airway management and insertion of oropharyngeal airway before training were 43 (95.6%), 38 (84.4%) and 12 (26.7%) respectively. These increased to 45 (100%), 42 (93.3%) and 43 (95.6%), respectively, after training. Nine (20%) teams decided CPR onsite before training and 35 (77.8%) after training. The average rate of chest compressions before and after training was 120.3 ± 17.9 and 123.2 ± 17.1 compressions per minute, respectively (p>0.05).

Conclusion

Training using established clinical pathway significantly improves the quality of CPR and increases the use of ALS techniques. CPR training requires ongoing validation and optimisation to maintain effectiveness. (Hong Kong j.emerg.med. 2015;22:14-22)

Context in Quality of Care: Improving Teamwork and Resilience

Quality improvement in health care is an ongoing challenge. Consideration of the context of the health care system is of paramount importance. Staff resilience and teamwork climate are key aspects of context that drive quality. Teamwork climate is dynamic, with well-established tools available to improve teamwork for specific tasks or global applications. Similarly, burnout and resilience can be modified with interventions such as cultivating gratitude, positivity, and awe. A growing body of literature has shown that teamwork and burnout relate to quality of care, with improved teamwork and decreased burnout expected to produce improved patient quality and safety.

Influence of Gender on the Performance of Cardiopulmonary Rescue Teams: A Randomized, Prospective Simulator Study

OBJECTIVES

Little is known about the influence of gender on resuscitation performance which may improve future education in resuscitation. The aim of this study was to compare female and male rescuers in regard to cardiopulmonary resuscitation and leadership performance.

DESIGN

Prospective, randomized simulator study.

SETTING

High-fidelity patient simulator center of the medical ICU, University Hospitals Basel (Switzerland).

SUBJECTS

Two hundred sixteen volunteer medical students (108 females and 108 males) of two Swiss universities in teams of three.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We analyzed data on the group and the individual level separately. The primary outcome on the group level was the hands-on time within the first 180 seconds after the onset of the cardiac arrest. Compared with male-only teams, female-only teams showed less hands-on time (mean ± SD) (87 ± 41 vs 109 ± 33 s; p = 0.037) and a longer delay before the start of chest compressions (109 ± 77 vs 70 ± 56 s; p = 0.038). Additionally, female-only teams showed a lower leadership performance in different domains and fewer unsolicited cardiopulmonary resuscitation measures compared with male-only teams. On the individual level, which was assessed in mixed teams only, female gender was associated with a lower number of secure leadership statements (3 ± 2 vs 5 ± 3; p = 0.027). Results were confirmed in regression analysis adjusted for team composition.

CONCLUSIONS

We found important gender differences, with female rescuers showing inferior cardiopulmonary resuscitation performance, which can partially be explained by fewer unsolicited cardiopulmonary resuscitation measures and inferior female leadership. Future education of rescuers should take gender differences into account.

Teamwork in the NICU Setting and Its Association with Health Care-Associated Infections in Very Low-Birth-Weight Infants

Background and Objective Teamwork may affect clinical care in the neonatal intensive care unit (NICU) setting. The objective of this study was to assess teamwork climate across NICUs and to test scale-level and item-level associations with health care-associated infection (HAI) rates in very low-birth-weight (VLBW) infants. Methods Cross-sectional study of the association between HAI rates, defined as any bacterial or fungal infection during the birth hospitalization, among 6,663 VLBW infants cared for in 44 NICUs between 2010 and 2012. NICU HAI rates were correlated with teamwork climate ratings obtained in 2011 from 2,073 of 3,294 eligible NICU health professionals (response rate 63%). The relation between HAI rates and NICU teamwork climate was assessed using logistic regression models including NICU as a random effect. Results Across NICUs, 36 to 100% (mean 66%) of respondents reported good teamwork. HAI rates were significantly and independently associated with teamwork climate (odds ratio, 0.82; 95% confidence interval, 0.73-0.92, p = 0.005), such that the odds of an infant contracting a HAI decreased by 18% with each 10% rise in NICU respondents reporting good teamwork. Conclusion Improving teamwork may be an important element in infection control efforts.

Interdisciplinary onsite team-based simulation training in the neonatal intensive care unit: a pilot report

OBJECTIVE

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.

STUDY DESIGN

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.

RESULTS

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.

CONCLUSION

With appropriate planning and implementation, TBST is feasible and realistic in a busy NICU.