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Simulation-Based Clinical System Testing of Neonatal Resuscitation Readiness Across a Rural Health System Identifies

Jeffrey Holmes, Micheline Chipman, Beth Gray

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Summary

Simulation-based clinical systems testing identified common safety threats in neonatal resuscitation across rural hospitals. This approach helps prioritize interventions and improve patient safety through systemwide analysis.

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Area of Science:

Healthcare simulation
Patient safety research
Neonatal care

Background:

Simulation-based clinical systems testing (SbCST) is a valuable tool for practicing neonatal resuscitation.
It aids in identifying and quantifying latent safety threats (LSTs) within clinical systems.
This study focused on in situ training in eight rural delivery hospitals.

Purpose of the Study:

To categorize and quantify LSTs during in situ neonatal resuscitation training.
To determine if LSTs are common across multiple rural hospitals.
To inform systemwide safety improvement strategies.

Main Methods:

Conducted half-day training sessions for 177 interprofessional delivery room team members between May 2019 and May 2023.
Utilized skills stations, in situ simulations, and facilitated debriefs.
Applied Healthcare Failure Mode and Effect Analysis (HFMEA) rubrics to identify and compare LSTs across sites.

Main Results:

Identified 67 distinct LSTs, with 61.2% shared across multiple hospitals.
LSTs fell into five systems and three teams categories.
Key LSTs found in >=75% of hospitals included unclear transfusion protocols, inconsistent communication, resource access, and recorder use.

Conclusions:

SbCST across health systems enables comparison of LSTs and identification of common mitigation opportunities.
Systemwide analysis provides data for resource allocation and solution implementation.
Identifying LST themes can guide prospective readiness efforts in hospitals not yet participating in simulation testing.