Improving Rural Neonatal Birth Outcomes through Neonatal Resuscitation Simulation Training

A rapid and skillful neonatal resuscitation, performed by a confident and knowledgeable medical team, is crucial to reducing neonatal morbidity and mortality. Maine is the most rural state in the United States and two- thirds of hospitals have low birth rates of less than one newborn per day. This low birth rate precludes clinical teams from having regular opportunities to maintain essential neonatal resuscitation skills. Strategies to improve and maintain neonatal resuscitation skills at rural hospitals are urgently needed and essential to preserve maternal and infant care at critical access hospitals. In situ simulation training has been shown to be an effective training tool, allowing delivery room teams to deliberately practice resuscitation skills on a mannequin in their native clinical setting with experts present to provide guidance and lead a team debriefing following the training session. This training allows rural clinicians to practice essential resuscitation skills including adherence to the Neonatal Resuscitation Program (NRP) guidelines, teamwork and communication through scenarios created to intentionally replicate critical clinical situations. Clinicians then receive directed feedback in debriefing sessions following the simulation training to review their performance and assess for areas of improvement. Though effective, in situ simulation training in rural hospitals is dependent upon the availability of experts and is cost prohibitive due to the expensive simulation equipment. Telesimulation is an alternative method of providing simulation training and employs many of the principles of in situ simulation training, with remote participation from experts for observation and debrief support. In a pilot study, we demonstrated that regular monthly telesimulation training for 12 months at one rural hospital led to substantial improvements in adherence to NRP, teamwork and communication scores. In the proposed randomized non-inferiority cluster trial, we will compare two types of telesimulation technology and employ implementation science to ensure consistency in the approach across different institutions as well as develop a framework to enable implementation at other sites. Specifically, we will test an innovative mixed reality hologram (HoloBabyTM) that our research group has developed and patented against the current high-fidelity standard mannequin telesimulation used in our pilot study. The primary outcome is the performance of the medical teams during a resuscitation as measured by a score evaluating adherence to the gold standard NRP guideline. Communication and teamwork will also be assessed as secondary outcomes and using The Mayo High Performance Teamwork Scale. The HoloBabyTM leverages novel technology to provide a less expensive alternative to make simulation training more widely accessible to rural community hospitals allowing rural clinicians to deliberately practice resuscitation skills, prioritizing learning and competence, without compromising patient safety.