In situ simulation of neonatal resuscitation to improve team performance and clinical outcomes

项目摘要 新生儿复苏由于其复杂性，对医疗团队来说可能具有挑战性，需要 内容知识、技术技能、行为技能和团队合作的结合。模拟训练 一种工具可以解决这种复杂的技能，也可以解决在这种情况下复苏的罕见性， 早产或缺氧缺血性脑病。虽然模拟在新生儿中很常见 复苏培训，使用模拟对实际临床结果的有效性是未知的。 我们将测试是否使用现场模拟训练-模拟训练在实际设置， 医疗团队实践-提高团队绩效和临床结果。这一假设将得到检验 在一个大型的基于人群的质量改进网络中进行的阶梯楔形试验中。阶梯式楔形试验 允许所有参与者接受干预，从而提高招募能力， 参与者从干预中受益。在这种设计中，干预是随着时间的推移推出的， 中心比其他人更早开始。每个中心都可以作为自己的控制中心， 来做比较。本研究项目的背景将是加州围产期质量保健 协作（CPQCC），新生儿重症监护病房的人口为基础的网络。CPQC包括两个 学术和社区单位，这意味着结果将是普遍的。CPQCC已经有一个 现有数据基础设施，包括孕产妇和新生儿数据，包括2岁时的随访数据 提供了一个研究类似网络中不存在的结果的机会。 在这个项目中，40家医院将参与一个经过验证的新生儿质量改进模型， 复苏术每个单位将逐步学习和实施现场模拟。的设置 CPQC为研究培训计划对重要临床结果的影响提供了独特的机会 早产是新生儿死亡和长期发病的最常见原因。在目标1中，我们 评估原位模拟是否能改善早产儿的临床结局。在目标2中，我们将评估 在模拟中更好的团队表现是否预示着更好的临床结果。这将有助于通知 新生儿复苏的培训方法和评估。在目标3中，我们将研究促进者， 医院之间开展模拟培训的障碍。这将为培训的实施提供信息 在各医院开展项目，以改善新生儿复苏。在目标4中，我们将评估执行经济 现场模拟和实施评估。 这项研究的结果将提供一个更清晰的理解如何模拟可以被用作一个 评估工具，更重要的是它对改善临床结果的影响。

Project Summary Neonatal resuscitation can be challenging for healthcare teams due to its complex nature, requiring a combination of content knowledge, technical skills, behavioral skills, and teamwork. Simulation as a training tool can address this complex skill and also address the infrequent nature of resuscitations in conditions such as very preterm birth or hypoxic ischemic encephalopathy. While simulation is common in neonatal resuscitation training, the effectiveness of using simulation on actual clinical outcomes is unknown. We will test whether using in situ simulation training – simulation training in the actual setting that healthcare teams practice – improves team performance and clinical outcomes. This hypothesis will be tested in a stepped wedge trial in a large population-based quality improvement network. A stepped wedge trial allows for all participants to receive the intervention, and therefore increases recruitment ability and gives all participants to benefit from the intervention. In this design, the intervention is rolled out over time with some centers starting earlier than others. Each center is able to then serve as its own control, increasing the power to make comparisons. The setting of this research project will be the California Perinatal Quality Care Collaborative (CPQCC), a population-based network of neonatal intensive care units. CPQCC includes both academic and community units, which means that results will be generalizable. CPQCC already has an existing data infrastructure that includes maternal and neonatal data, including follow-up data at 2 years of age giving an opportunity to study outcomes that does not exist in similar networks. In this project, 40 hospitals will engage in a proven quality improvement model for neonatal resuscitation. In a stepwise fashion, each unit will learn and implement in situ simulation. The setting of the CPQCC allows for a unique opportunity to study the impact of training programs on important clinical outcomes for the most common cause of mortality and long-term morbidity in newborns, preterm birth. In Aim 1, we will assess whether in situ simulation improves clinical outcomes for preterm infants. In Aim 2, we will assess whether better team performance in simulation predicts better clinical outcomes. This will help to inform training methodologies and assessment in neonatal resuscitation. In Aim 3, we will examine facilitators and barriers of implementing simulation training across hospitals. This will inform the implementation of training programs across hospitals to improve neonatal resuscitation. In Aim 4, we will evaluate perform an economic evaluation of in situ simulation and implementation. The results of this research will provide a clearer understanding of how simulation can be used as an assessment tool, and more importantly the impact that it can have on improving clinical outcomes.