404 - One-Hour Simulation Improves Neonatal Resuscitation Skills of Non-Neonatal Resuscitation Program Certified Emergency Medicine Residents

Publication Number: 404.5720

Rachel Reed, Icahn School of Medicine at Mount Sinai, Tenafly, NJ, United States; Michael Thompson, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Aneury Hernandez, Mount Sinai, Astoria, NY, United States; Guillaume Stoffels, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Jo Hsuan Lee, Mount Sinai Hospital System, New York City, NY, United States; Sushma Krishna, Icahn School of Medicine at Mount Sinai, Harrington Park, NJ, United States

Background: Infants born in the Emergency Department (ED) have high rates of morbidity and mortality. The American Academy of Pediatrics and the American College of Emergency Physicians recommend that Emergency Medicine (EM) physicians should develop competency in neonatal resuscitation (NR). However, EM residents are not required to obtain Neonatal Resuscitation Program (NRP©) certification or complete any standardized NR curriculum. Many EM residents graduate with little exposure to NR. Lack of competency and comfort with NR could lead to adverse patient outcomes and provider anxiety.

Objective: To determine whether a 1-hour, NR simulation curriculum improves EM resident skills, competency, and level of comfort with NR.

Design/Methods: We developed a 1-hour simulation curriculum led by attending neonatologists for senior EM residents. We used the validated Neonatal Resuscitation Performance Evaluation (NRPE) scoring tool to assess each resident’s baseline skills in a 7-minute simulation conducted pre- and post-session. Time to each successful intervention performed during the simulation was timed.

Each resident completed a survey pre and post the teaching session and again at the end of the academic year (post-post survey). The survey consisted of level of experience questions, NR knowledge and skills questions.

Results: Participants included 14 third-year EM residents.

There was a significant median improvement of 57 points (38%) in the total NRPE score, 12 points in the NRPE subset score of the bag-mask ventilation (BVM) skill, 6 points in the intubation score, and 18 points in the chest compressions score (p < 0.05), Fig 1. There was a significant decrease in the median time to obtaining initial heart rate (HR), time to starting positive pressure ventilation (PPV), time to successful intubation and increase time to chest compressions (p < 0.05, Fig 2).

There was a significant median improvement in all 4 self-reported competency questions. Scores increased by a median of 2 Likert score levels in questions 1, 3, and 4, and by 1 level in question 2, p< 0.05. This improvement was maintained for questions 1 and 3 in the post-post survey as compared to the pre-simulation survey. There was a significant improvement in the knowledge assessment score (6 [6, 6] vs. 5 [4, 5] points, p=0.004) between the pre- and post-intervention survey.

Conclusion(s): This 1-hour, NR skill-based simulation teaching session improved NR skills, knowledge and self-reported competency in senior EM residents. Similar sessions could provide important exposure to NR that is often lacking in EM residency.

Figure 1. NRPE Evaluation Tool Scores


Figure 2. Time to Achieve Critical Steps in NRP Algorithm