523 - Improving neonatal resuscitation skills at rural community hospitals through a novel method of remote high-fidelity telesimulation.

Poster Number: 523
Publication Number: 523.327

Lee Donohue, University of California Davis Children's Hospital, Sacramento, CA, United States; Shoshana Newman-LIndsay, University of California Davis Health System (UC Davis) - Sacramento, CA, Sacramento, CA, United States; Peggy Chen, Miller Children's & Women's Hospital Long Beach, Los angeles, CA, United States; Jennifer Weber, Phoenix Children's Hospital, University of Arizona College of Medicine, Phoenix, AZ, United States; Kristin R. Hoffman, University of California, Davis, School of Medicine, Sacramento, CA, United States

Background: Neonatal resuscitation is a high acuity, low occurrence event and an essential skill at rural community hospitals. Traditionally, staff at small hospitals receive relatively infrequent in-person training, such as biannual renewal of Neonatal Resuscitation Program (NRP) certification. Common barriers to more frequent training include availability of trainers and equipment and the need to travel to remote training sites with more sophisticated simulation equipment. Recent technological advances have led to the emergence of telesimulation, which combines the benefits of simulation-based teaching and remote videoconferencing to allow for relatively easy, inexpensive, and widespread teaching and practice by simulation.

Objective: The goals of this study were to bring more intensive and frequent neonatal resuscitation training to rural hospitals via telesimulation and to measure the efficacy of this training.

Design/Methods: Two rural community hospitals participated. Baseline measurements were made by in-person site visits during which staff participated in multidisciplinary simulated neonatal resuscitations. Simulations were analyzed by NRP trained neonatologists or neonatal fellows using an adapted version of a validated scoring tool to measure adherence to the NRP algorithm. During the 1-year intervention period, a remote connection to an on-site high-fidelity neonatal patient simulator and pre-existing telemedicine equipment were used to conduct neonatal resuscitation training sessions. Each of these sessions lasted 30-45 minutes with a simulated neonatal resuscitation followed by a debriefing. 2 sessions per month were offered to each site. Measurements were again made during in-person site visits following the intervention period. 

Results: There was an improvement in NRP performance scores with regular telesimulation training sessions. The mean of scores pre-intervention was 87% vs 94% post-intervention (p = 0.001). The difference was more pronounced if the sites were separated. Site 2, which completed 24 telesimulation session during the intervention period, demonstrated an improvement in NRP performance scores (95% vs 87%, p = 0.0002). However, this difference was not seen at site 1 where 10 telesimulation sessions were completed (93% vs 88%, p = 0.1336).

Conclusion(s): Remote high-fidelity neonatal telesimulation is a feasible way to conduct neonatal resuscitation training between large academic centers and rural community sites. Regular neonatal resuscitation telesimulation training may lead to an improvement in adherence to the NRP algorithm.