P3.238: Multidisciplinary Simulation Increases Confidence in Handling Zero-Notice Neonatal Emergencies

Background: While newborn emergencies can often be anticipated during planned deliveries, they can occur anywhere where pregnant patients and neonates are located. Providers and nursing staff who do not routinely perform neonatal resuscitation are often first responders to these zero-notice events. Such events pose a major safety risk due to delays in initiation of effective neonatal resuscitation. Multidisciplinary in-situ simulation can improve confidence in managing the initial minutes of these emergencies while awaiting specialized support and can reduce systems barriers to initiating resuscitation in this setting.

Methods: An in-situ simulation curriculum for common zero-notice neonatal emergencies was developed. Simulations were designed to be completed in 15-30 minutes to minimize disruption to patient care. All simulations utilized high-fidelity preterm or term manikins. Simulations were conducted jointly by physicians and nurse educators at least quarterly in the Antepartum (APU), Triage, Mother-Baby (MBU), and Labor and Delivery (L&D) units at Barnes Jewish Hospital and encompassed both day and night shifts. Contact time with participants included pre-briefing, simulation, and debriefing. Post-simulation electronic survey data was collected to assess the efficacy and impact of these simulations on participants. Systems barriers to resuscitation identified in debriefing and resulting changes were tracked.

Results: Between May 2022 and March 2025, 35 in-situ simulations were conducted in the 4 locations (Figure 1). Participants included nursing staff, pediatric and obstetric residents, neonatal fellows and attendings, neonatal and obstetric nurse practitioners, nursing and medical students, and patient care technicians. Survey data was available from 102 participants in 23 simulations encompassing 40.8 contact hours. 81% (83/102) of respondents were RN staff. 89% (91/102) reported that simulation participation increased their confidence in handling a neonatal emergency on their unit. Pre- and post-simulation Likert confidence data were available for 28 participants (Figure 2). 96% (98/102) said the simulation increased their knowledge in handling a neonatal emergency. 95% (97/102) responded that they wanted further simulation-based learning opportunities. Free-responses on educational points emphasized increased familiarity with how to call for help, the location and use of neonatal resuscitation equipment, and recognition of indications for PPV. Systems changes made from simulation feedback included placement of cognitive aids on resuscitation tables, addition of a precipitous delivery kit to the APU, and changes to neonatal crash cart labeling.

Conclusion: Multidisciplinary in-situ simulation increases participant confidence in handling zero-notice neonatal emergencies. These simulations can be conducted efficiently on the unit to maximize impact while minimizing disruption to patient care and are well-received by participants. Additionally, systems barriers to handling of neonatal emergencies can be identified and addressed. Future directions include examining the impact of in-situ simulation on time to call for help and initiation of PPV both in simulation and in actual neonatal emergencies.