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NEXT STEPS CONCLUSIONS MISSION and VISION Using Quality Improvement Methods to Improve Neonatal Resuscitation Simulation Based Education Defining improvement opportunity phase Anne Ades 1,2 , Shela Siddiqi 1 , Crystal White 1 , Jean Marie Carroll 1 , John Chuo 1, 2 1.Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA 2.Perelman School of Medicine at the University of Pennyslvania CONTEXT QUALITY IMPROVEMENT FRAMEWORK USED IN PROJECT DEVELOPMENT 9 th International Pediatric Simulation Symposium and Workshops 2017 1-3 June, Boston, MA, USA Mission: To use rigorous quality improvement methodology to improve NRP courses in the CNBCN Sites Define and diagnose phases: 1. Iden2fied leaders 2. Developed primary outcome 3. Brainstormed items for Fishbone (Figure 1) and Driver Diagram (Figure 2) 4. Using items iden2fied in the Fishbone and Driver Diagrams developed survey for baseline data collec2on and poten2al specific opportuni2es for improvement Survey focus areas: 1. Educa2on of NRP Instructors in simula2on and debriefing 2. Adherence of NRP Instructors to NRP suggested format 3. Resources available for NRP courses 4. Ra2ng of the quality of NRP courses and Instructors from par2cipant’s feedback Figure 1 Figure 2 Children’s Hospital of Philadelphia (CHOP) Newborn Care Network (CNBCN) encompasses 13 sites with approximately 30,000 births annually. Several clinically focused quality improvement projects have been successfully accomplished throughout the CNBCN. Neonatal Resuscita2on Program (NRP) recommends simula2on(for both forma2ve and summa2ve uses) depending on exis2ng skill level of par2cipant. Teaching NRP Instructors in simula2on and debriefing by NRP was historically done in a sta2c non-mentored on-line format. New 2015 NRP Guidelines require mentoring of Instructor candidates in their simula2on and debriefing skills aZer the on-line materials are completed. SURVEY RESULTS Objec2ves: 1. To iden2fy gaps in NRP educa2on in the CNBCN 2. To develop interven2ons to resolve the gaps 3. To demonstrate that the use of quality improvement methodology can improve educa2onal processes and outcomes Vision: Improving NRP courses will improve delivery of care in the delivery rooms Several ques2ons were raised by this change and by self-report of NRP Provider course par2cipants: 1. Are current Instructors as well-trained in their simula2on and debriefing skills as they should be? 2. Will they be able to adequately mentor Instructor candidates to ensure the Instructor candidate’s skill are adequate? 3. Do we know if current prac2ce regarding CNBCN NRP course delivery is op2mal? Survey: •494 Inter-professional and mul2-disciplinary respondents Overall: •24% of NRP Instructors have not had training in simula2on and debriefing outside of the on-line educa2on •17% of Instructors have “passed” a learner that performed sub- op2mally •Increasing frequency of simula2ons was the most frequent sugges2on to improve NRP educa2on Selected NRP Instructor Survey Responses Selected NRP Provider Survey Responses Based on survey responses, the following areas were iden2fied as poten2al opportuni2es for improvement: 1. Increasing interprofessional par2cipa2on in NRP courses. 2. Providing hands-on training in simula2on and debriefing skills for Instructors. 3. Ensuring Instructors have resources and skills to help the poorly performing learner. 4. Discussing with network administra2ons the need for dedicated equipment and Instructor support so CNBCN sites can op2mize their NRP courses. Based on the survey, we have iden2fied high performing sites where we can further inves2gate their prac2ces for incorpora2on in an improvement strategy. Based on feedback of par2cipants in the Kick-Off mee2ng, we distributed individual Site results for local review and evalua2on with a plan to meet again in June, 2017. This mee2ng will focus on process mapping the steps necessary to implement specific improvement measures and interven2ons across the CNBCN.

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NEXTSTEPS

CONCLUSIONS

MISSIONandVISION

Using Quality Improvement Methods to Improve Neonatal Resuscitation Simulation Based Education

Defining improvement opportunity phase Anne Ades1,2, Shela Siddiqi1, Crystal White1, Jean Marie Carroll1, John Chuo1, 2

1. Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA 2. Perelman School of Medicine at the University of Pennyslvania

CONTEXT

QUALITYIMPROVEMENTFRAMEWORKUSEDINPROJECTDEVELOPMENT

9th International Pediatric Simulation Symposium and Workshops 2017

1-3 June, Boston, MA, USA

Mission:TouserigorousqualityimprovementmethodologytoimproveNRPcoursesintheCNBCNSites

Defineanddiagnosephases:1. Iden2fiedleaders2. Developedprimaryoutcome3. BrainstormeditemsforFishbone(Figure1)andDriverDiagram(Figure2)4. Usingitemsiden2fiedintheFishboneandDriverDiagramsdevelopedsurveyforbaselinedatacollec2onandpoten2alspecificopportuni2esforimprovementSurveyfocusareas:1. Educa2onofNRPInstructorsinsimula2onanddebriefing2. AdherenceofNRPInstructorstoNRPsuggestedformat3. ResourcesavailableforNRPcourses4. Ra2ngofthequalityofNRPcoursesandInstructorsfrompar2cipant’sfeedback

Figure1 Figure2

Children’sHospitalofPhiladelphia(CHOP)NewbornCareNetwork(CNBCN)encompasses13siteswithapproximately30,000birthsannually.

SeveralclinicallyfocusedqualityimprovementprojectshavebeensuccessfullyaccomplishedthroughouttheCNBCN.

NeonatalResuscita2onProgram(NRP)recommendssimula2on(forbothforma2veandsumma2veuses)dependingonexis2ngskilllevelofpar2cipant.

TeachingNRPInstructorsinsimula2onanddebriefingbyNRPwashistoricallydoneinasta2cnon-mentoredon-lineformat.

New2015NRPGuidelinesrequirementoringofInstructorcandidatesintheirsimula2onanddebriefingskillsaZertheon-linematerialsarecompleted.

SURVEYRESULTS

Objec2ves:1.  Toiden2fygapsinNRPeduca2onintheCNBCN2.  Todevelopinterven2onstoresolvethegaps3.  Todemonstratethattheuseofqualityimprovementmethodologycanimproveeduca2onalprocessesandoutcomes

Vision:ImprovingNRPcourseswillimprovedeliveryofcareinthedeliveryrooms

Severalques2onswereraisedbythischangeandbyself-reportofNRPProvidercoursepar2cipants:

1. ArecurrentInstructorsaswell-trainedintheirsimula2onanddebriefingskillsastheyshouldbe?2. WilltheybeabletoadequatelymentorInstructorcandidatestoensuretheInstructorcandidate’sskillareadequate?

3. Doweknowifcurrentprac2ceregardingCNBCNNRPcoursedeliveryisop2mal?

Survey:• 494Inter-professionalandmul2-disciplinaryrespondentsOverall:• 24%ofNRPInstructorshavenothadtraininginsimula2onanddebriefingoutsideoftheon-lineeduca2on• 17%ofInstructorshave“passed”alearnerthatperformedsub-op2mally• Increasingfrequencyofsimula2onswasthemostfrequentsugges2ontoimproveNRPeduca2on

Selected NRP Instructor Survey Responses Selected NRP Provider Survey Responses

Basedonsurveyresponses,thefollowingareaswereiden2fiedaspoten2alopportuni2esforimprovement:1. Increasinginterprofessionalpar2cipa2oninNRPcourses.2. Providinghands-ontraininginsimula2onanddebriefingskillsforInstructors.3. EnsuringInstructorshaveresourcesandskillstohelpthepoorlyperforminglearner.4. Discussingwithnetworkadministra2onstheneedfordedicatedequipmentandInstructorsupportsoCNBCNsitescanop2mizetheirNRPcourses.Basedonthesurvey,wehaveiden2fiedhighperformingsiteswherewecanfurtherinves2gatetheirprac2cesforincorpora2oninanimprovementstrategy.

Basedonfeedbackofpar2cipantsintheKick-Offmee2ng,wedistributedindividualSiteresultsforlocalreviewandevalua2onwithaplantomeetagaininJune,2017.Thismee2ngwillfocusonprocessmappingthestepsnecessarytoimplementspecificimprovementmeasuresandinterven2onsacrosstheCNBCN.