Simulation Education for Preterm Infant Delivery Room Management at Community Hospitals

BACKGROUND: Preterm infants are at risk for hypothermia in the delivery room (DR). Hypothermia and community hospital delivery are factors associated with increased morbidities and mortality in preterm infants. Community hospital providers have less experience with preterm deliveries and thermoregulation methods in the DR.

METHODS: Community hospital DR providers in Indiana completed a cognitive test evaluating preterm infant DR management. A simulation-based team assessment was evaluated by using a scoring tool. After debriefing, the simulation performance was repeated and rescored. Afterward, providers completed a cognitive knowledge posttest. Eleven to eighteen months later, sites were revisited with cognitive knowledge and team simulated scenarios reassessed.

RESULTS: Twenty-five community hospitals with >400 multidisciplinary providers participated in the initial study visit. Average pre- and posttest scores were 48.8% and 94.1% respectively (P value <.001). Participants performed an average of 22.8 of 36 scoring items during a simulated preterm delivery including 4.4 of 8 thermoregulation related actions. Performance immediately improved in a statistically significant manner during the repeat scenario. When sites were revisited, participants performed an average of 26.7 of 36 scoring items including 6.1 of 8 thermoregulation actions during a simulated preterm delivery a statistically significant (P <.001) improvement from the initial visit.

CONCLUSIONS: Simulation education regarding preterm infant DR management improved community providers immediate knowledge and skills and also follow-up performance at ∼1 year. In simulation, providers performed thermoregulation maneuvers more often and efficiently, critical to resuscitation because delays in thermoregulation can significantly adversely affect outcomes.