Center of Biomedical Research Excellence in Acute Care Research and Rural Disparities

Project Summary Rural outcomes following high acuity, low occurrence (HALO) conditions are suboptimal. During resuscitation of neonates, a HALO event, rapid access to appropriately equipped and trained medical personnel capable of delivering time-sensitive medical interventions is essential, or the consequences

are dire, including mortality and significant morbidity. The Neonatal Resuscitation Program (NRP®), a national guideline and training program, designed to standardize care and improve adherence to care algorithms, is delivered every two years. However, knowledge and technical skills involved in adherence to best practices typically degrade over two to three months if the skills are not used

clinically. For high-volume, urban teaching hospitals, there is sufficient volume to maintain skills. For lower volume rural and community hospitals, there is a lack of opportunities to maintain skills, including Maine, where neonatal resuscitation is a true HALO event with the vast majority of hospitals

delivering less than one infant a day and very few newborns needing any resuscitation. High volume centers across various populations have better outcomes, and in emergencies, patients in lower volume centers experience higher rates of medication errorsand differences in adherence to care algorithms. Studies estimate that 20-40% of neonatal lives could be saved with proper neonatal

resuscitation and are dependent upon a rapid, knowledgeable, and skillful response. There is an urgent need to increase rural community hospital readiness and solutions to improve neonatal HALO related care delivery. The overall goal of the parent grant, the NIH COBRE in Acute Care Research and Rural Disparities, is to support and develop strategies to reduce health disparities due to rurality.

This supplement grant proposal seeks to decrease the healthcare disparities experienced by rural patients by targeting team-based performance training for neonatal resuscitation. We aim to conduct a pilot crossover study comparing team performance in NRP®, teamwork, and communication skills with HoloBabyTM (a novel mixed reality neonatal manikin prototype) and HiFi manikin simulation. We

will compare team performance in simulations using HoloBabyTM and HiFi training. Simulations will be video recorded and investigators will rate NRP® adherence, teamwork, and communication using standardized scoring tools. We hypothesize teams’ performance with the different simulation technologies will be equivalent. We also aim to evaluate the psychometric properties of the modified

NRP® adherence assessment tool. We will use data collected in Aim 1, in addition to existing assessment data, to examine estimates of reliability and validity for the NRP® assessment tool. We hypothesize the modified NRP® assessment tool is a sufficiently valid and reliable tool for measuring team performance in the simulated environment and will not differ according to simulator type.

To achieve our proposed aims, a diverse skill set, expertise, and team approach will be essential. This project aims to leverage simulation expertise, including the neonatal simulation expertise of Drs. Zanno and Melendi and the pediatric simulation experience of Dr. Mallory. The project will utilize

simulation expertise through the Hannaford Center for Safety, Innovation, and Simulation (HCSIS), a high throughput simulation center for MaineHealth that reaches approximately 5,000 clinicians per year across Maine. Dr. Strout has extensive training and experience in the conduct of clinical and educational research across the lifespan, which includes qualitative, quantitative, and mixed

methodologies as well as psychometrics and measure development and evaluation. Together, this team is poised to successfully achieve the aims proposed here, advancing scientific understanding in this area and improving neonatal care delivery in rural communities.