Testing of midwife neonatal resuscitation skills with a simulator manikin in a low-risk delivery unit.

BACKGROUND: Expertise in neonatal resuscitation is essential for personnel involved in the care of newborns. In this observational cohort study the skills of 52 midwives in a simulated scenario were assessed. METHODS: A total of 52 midwives in a low-risk unit and five specialist nurses in a high-risk unit were tested to establish their competence in newborn resuscitation. The 52 midwives were divided into groups 1 (n = 39; no pretest training) and 2 (n = 13; 1 day training prior to study). The video-recorded test scenario was a newborn with asphyxia. Thirty items were graded by a neonatologist and nursing team in real time. Using the Angoff method, a pass score was 18.71 for skills that were graded 0 or 1. RESULTS: The average score of specialist nurses was 26 (range, 23-29). A total of 49% of midwives in group 1 and 92% in group 2 passed the test. The average score was 17.7 (range, 9-25) in group 1 and 21.9 (range, 17-27) in group 2. A total of 27% and 77% of midwives in groups 1 and 2, respectively, carried out ventilation at a frequency as per the algorithm. Mask leakage was higher in group 1 (44%) versus group 2 (23%). Five and three midwives in groups 1 and 2, respectively, overexpanded the lungs. CONCLUSION: Many midwives had imperfect resuscitation skills. A 1 day course improved such skills. The standard scenario is an objective and useful performance marker in assessing and documenting improvements in competence in delivery room resuscitation.

Effect of a simulation-based workshop on multidisplinary teamwork of newborn emergencies: an intervention study.

BACKGROUND: Video analyses of real-life newborn resuscitations have shown that Neonatal Resuscitation Program (NRP) guidelines are followed in fewer than 50% of cases. Multidisciplinary simulation is used as a first-rate tool for the improvement of teamwork among health professionals. In the study we evaluated the impact of the crisis resource management (CRM) and anesthesia non-technical skills instruction on teamwork during simulated newborn emergencies. METHODS: Ninety-nine participants of two delivery units (17 pediatricians, 16 anesthesiologists, 14 obstetricians, 31 midwives, and 21 neonatal nurses) were divided to an intervention group (I-group, 9 teams) and a control group (C-group, 6 teams). The I-group attended a CRM and ANTS instruction before the first scenario. After each scenario the I-group performed either self- or peer-assessment depending on whether they had acted or observed in the scenario. All the teams participated in two and observed another two scenarios. All the scenarios were video-recorded and scored by three experts with Team Emergency Assessment Measure (TEAM). SPSS software and nlme package were used for the statistical analyses. RESULTS: The total TEAM scores of the first scenario between the I- and C-group did not differ from each other. Neither there was an increase in the TEAM scoring between the first and second scenario between the groups. The CRM instruction did not improve the I-group's teamwork performance. Unfortunately the teams were not comparable because the teams had been allowed to self-select their members in the study design. The total TEAM scores varied a lot between the teams. Mixed-model linear regression revealed that the background of the team leader had an impact on differences of the total teamwork scores (D = 6.50, p = 0.039). When an anesthesia consultant was the team leader the mean teamwork improved by 6.41 points in comparison to specialists of other disciplines (p = 0.043). CONCLUSION: The instruction of non-technical skills before simulation training did not enhance the acquisition of teamwork skills of the intervention groups over the corresponding set of skills of the control groups. The teams led by an anesthesiologist scored the best. Experience of team leaders improved teamwork over the CRM instruction.

Assessment of newborn resuscitation skills of physicians with a simulator manikin.

OBJECTIVE: Education of medical staff according to Neonatal Resuscitation Program guidelines improves outcome of delivery room resuscitation. Regular assessment of skills is important for reliable performance of neonatal resuscitation. We assessed the practical resuscitation skills of clinicians in a standard scenario in a newborn simulation. DESIGN: Observational cohort study. MAIN OUTCOME MEASURES: The resuscitation skills of 6 consultant neonatologists, 11 paediatricians and 11 anaesthesiologists were assessed in a simulation. The standard test scenario was a newborn infant with asphyxia. A 30-item checklist was used for scoring technical skills, while non-technical skills were scored using a nine-item checklist. The pass/fail score was 18.66 for technical skills. Scoring was carried out by a neonatologist/anaesthesiologist team in real time. RESULTS: Two paediatricians and two anaesthesiologists failed the test. The average score was 25 for neonatologists, 22 for paediatricians and 20 for anaesthesiologists. Technical scores were compiled into four clusters for assessment of items in the same category. The scores in the ventilation cluster were lower the later the participants started ventilation, the longer they maintained pauses in ventilation, the older the baby at the time of intubation and the longer the time they used for intubation. The time intervals were checked from the video recordings. The neonatologists had better non-technical skills than the other groups. Good group-working skills correlated with high technical scores. CONCLUSIONS: Many clinicians exhibited inadequate skills to resuscitate a newborn infant in a standard scenario. The neonatologists, as clinical experts, performed best in both technical and non-technical skills testing.