Optimization and Sustainability of a Telesimulation Program (MOOSE) to Improve Neonatal Resuscitation

A rapid and skillful neonatal resuscitation, performed by a confident and knowledgeable medical team in the delivery room, is crucial to reducing neonatal morbidity and mortality rates. Neonatal resuscitation — the emergency procedure used to help a newborn establish a regular heartbeat and respiratory effort — represents a high acuity low occurrence event. Studies estimate that 20 to 40% of neonatal lives could be saved with proper neonatal resuscitation. However, in community hospitals in rural states like Maine, low birth rates prevent providers from regular opportunities to maintain essential neonatal resuscitation skills, which result in notable healthcare disparities between low and high birth volume hospitals. For instance, in two-thirds of rural hospitals in Maine, where fewer than one baby is born daily, declining proficiency in neonatal resuscitation skills has been linked to higher rates of unnecessary chest compressions, delayed airway management, brain injury, and infant mortality. There is a critical need to identify and develop strategies to improve and maintain neonatal resuscitation skills in rural hospitals. The overall goal of the parent grant — the COBRE in Acute Care Research and Rural Disparities — is to support and develop strategies to reduce healthcare disparities due to rurality. This grant proposal seeks to mitigate healthcare disparities experienced by infants born in rural hospitals by optimizing and sustaining a telesimulation training program for neonatal resuscitation. In Aim 1, we will analyze a longitudinal dataset of the telesimulations to identify training elements associated with improved team performance, such as team composition and training frequency that result in optimal team performance. In Aim 2, we will use implementation science methodology to study factors that influence a hospital’s ability to sustain ongoing participation in a neonatal telesimulation program independently. This aim will inform the development of an implementation toolkit for telesimulation in rural settings. Finally, in Aim 3, we will pilot and assess the feasibility of recording live deliveries with neonatal resuscitations. This pilot study serves as the initial step to being able to evaluate the effect of telesimulation training on real patient outcomes, as well as the longterm vision of developing a real-time telehealth support program for resuscitations. Upon completing these aims, our team will be poised to scale up the optimized telesimulation training model and live delivery room recording program across a broader network of rural hospitals, expanding our impact on healthcare disparities faced by rural newborns.