111. IMPLEMENTATION OF A NEONATAL QUALITY IMPROVEMENT SIMULATION PROGRAM FOR PEDIATRIC RESIDENTS

Abstract

Background Simulation-Based Medical Education is important in curriculum development and training in order to promote adequate teaching for trainees. At Connecticut Children's, simulation training is incorporated into the inpatient curriculum for pediatric residents with the exception of the neonatal intensive care unit (NICU). By implementing delivery room (DR) simulations, we hope to improve residents’ confidence in neonatal resuscitation skills. Aim Statement From November 2018 to December 2019, we aimed to improve pediatric resident confidence as assessed by serial surveys by 40% and improve Neonatal Resuscitation Program (NRP) skill proficiency measured by the number of correctly performed NRP steps by 25%. Interventions Residents completed a survey before and after their NICU rotation asking the following: I am confident in my ability to 1) perform bag mask ventilation, 2) participate in neonatal mock codes (NMCs), and 3) be team leader during NMCs. We implemented twice monthly DR simulations using standardized cases. Three PDSA cycles were completed. During cycle 1, DR simulations were implemented using laminated cards to present clinical information. A digital app was used in cycle 2 to present vital signs. The 2016 NRP algorithm card was provided for cycle 3 as a tool for reference. Measures Outcome measures included number of correct NRP steps and changes in resident confidence in resuscitation skills. Process measures included time to initiate positive pressure ventilation (PPV), resident participation and time to adequate ventilation. Balancing measures included missed actual deliveries and procedures in the NICU. Results Thirty-one residents (17 PL-1 and 14 PL-2) participated in the project. Residents’ confidence in ability to participate in NMCs increased by 17% and 18% and confidence in ability to lead NMCs increased by 27% and 20% for PL-1 and PL-2, respectively. Overall, residents reported increased confidence in resuscitation skills when comparing pre- and post-survey results. There was no difference in number of correctly performed NRP steps. Mean time to initiate PPV during the first simulation was 99+36.7s and 65.5+46.3s during the second simulation, giving an average decrease in time to initiate PPV of 33.5+44s, (p Conclusions and Next Steps DR simulations increase resident confidence in ability to participate in and lead NMCs. Simulation may increase residents’ proficiency in NRP skills demonstrated by improvement in time to initiate PPV.