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Am J Perinatol 2025; 42(06): 796-805
DOI: 10.1055/a-2421-8486
Original Article

Development and Evaluation of a Rural Longitudinal Neonatal Resuscitation Program Telesimulation Program (MOOSE: Maine Ongoing Outreach Simulation Education)

Misty Melendi‡   *
1   Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts
2   Section of Neonatal-Perinatal Medicine, Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
6   Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
,
Allison E. Zanno‡   *
1   Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts
2   Section of Neonatal-Perinatal Medicine, Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
6   Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
,
Jeffrey A. Holmes
3   Department of Emergency Medicine, Tufts University School of Medicine, Boston, Massachusetts
,
Micheline Chipman
4   Department of Simulation Education, The Hannaford Center for Safety, Innovation and Simulation, Maine Medical Center, Portland, Maine
,
Anya Cutler
5   Research Data Analyst, Maine Health Institute for Research, Center for Interdisciplinary Population and Health Research, Portland, Maine
,
Henry Stoddard
5   Research Data Analyst, Maine Health Institute for Research, Center for Interdisciplinary Population and Health Research, Portland, Maine
,
Leah M. Seften
6   Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
,
Anna Gilbert
6   Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
,
Mary Ottolini
6   Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
,
Alexa Craig 
1   Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts
6   Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
7   Division of Pediatric Neurology, Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
,
Leah A. Mallory
1   Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts
4   Department of Simulation Education, The Hannaford Center for Safety, Innovation and Simulation, Maine Medical Center, Portland, Maine
6   Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
› Author Affiliations Funding Funding was provided by the Department of Pediatrics at the Barbara Bush Children's Hospital at Maine Medical Center Philanthropy. Dr. Craig and Ms. Cutler were funded for their effort through the Center for Biomedical Research Excellence (COBRE) in Acute Care Research and Rural Disparities (grant no.: 1P20GM139745–01).
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Abstract

Objective

Neonatal resuscitation is a high-acuity, low-occurrence event and many rural pediatricians report feeling underprepared for these events. We piloted a longitudinal telesimulation (TS) program with a rural hospital's interprofessional delivery room teams aimed at improving adherence to Neonatal Resuscitation Program (NRP) guidelines and teamwork.

Study Design

A TS study was conducted monthly in one rural hospital over a 10-month period from November 2020 to August 2021. TS sessions were remotely viewed and debriefed by experts, a neonatologist and a simulation educator. Sessions were video recorded and assessed using a scoring tool with validity evidence for NRP adherence. Teamwork was assessed using both TeamSTEPPS 2.0 Team Performance Observation Tool and Mayo High-Performance Teamwork Scale.

Results

We conducted 10 TS sessions in one rural hospital. There were 24 total participants, who rotated through monthly sessions, ensuring interdisciplinary team composition was reflective of realistic staffing. NRP adherence rate for full code scenarios improved from a baseline of 39 to 95%. Compared with baseline data for efficiency, multiple NRP skills improved (e.g., cardiac lead placement occurred 12× faster, 0:31 seconds vs. 6:21 minutes). Teamwork scores showed improvement in all domains.

Conclusion

Our results demonstrate that a TS program aimed at improving NRP and team performance is possible to implement in a rural setting. Our pilot study showed a trend toward improved NRP adherence, increased skill efficiency, and higher-quality teamwork and communication in one rural hospital. Additional research is needed to analyze program efficacy on a larger scale and to understand the impact of training on patient outcomes.

Key Points

  • Optimal newborn outcomes depend on skillful implementation of NRP.

  • Telesimulation can deliver medical education that circumvents challenges in rural areas.

  • A longitudinal NRP TS program is possible to implement in a rural setting.

  • A rural NRP telesimulation program may improve interprofessional resuscitation performance.

  • A rural NRP telesimulation program may improve interprofessional resuscitation teamwork.

Keywords

simulation - neonatal resuscitation - telesimulation - rural health - interprofessional team training - program development

Authors' Contributions

A.Z. and M.M. conceptualized and designed the study, created data collection tools, conducted the investigation, provided study administration and supervision, drafted the original manuscript, critically reviewed and revised the manuscript. J.H. and M.C. conceptualized the study, conducted the investigation, drafted the original manuscript, critically reviewed, and revised the manuscript. A.Cu and H.S. performed data analysis and visualization of study results and critically reviewed and revised the manuscript. L.M.S. and A.G. provided programmatic and research oversight and drafted, edited, and critically reviewed the manuscript. M.O. conceptualized the study, supported funding acquisition, provided supervision, and critically reviewed and revised the manuscript. A.Cr supported funding acquisition and critically reviewed and revised the manuscript. L.M. conceptualized and designed the study, provided study supervision, drafted the original manuscript, critically reviewed, and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.


* Contributed equally as co-first authors.


Supplementary Material



Publication History

Received: 28 May 2024

Accepted: 25 September 2024

Accepted Manuscript online:
26 September 2024

Article published online:
22 October 2024

© 2024. Thieme. All rights reserved.

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