Equipment Standardization and In Situ Simulation for Emergent Delivery and Neonatal Resuscitation

Emergency departments (EDs) are increasingly managing emergent deliveries and neonatal resuscitations, with added challenges for hospitals without an obstetric unit. A system-level assessment identified variability in equipment and staff preparedness, including gaps at four small community hospital sites. This quality improvement initiative aimed to standardize equipment and improve readiness for high-acuity, low-frequency (HALO) events. To improve preparedness for emergent deliveries and neonatal resuscitations across four small community hospital EDs through standardized equipment kits and in-situ simulation training.

Standardized obstetric and neonatal resuscitation kits were created and deployed. A one-hour in-situ simulation-based training session was conducted during the annual skills fair for ED staff. A total of 85 staff members participated (69 nurses, 15 paramedics, and 1 technician). An 11-item pre- and post-training survey using a 4-point Likert scale (1-4) assessed confidence and perceived preparedness for emergent delivery, including maternal and neonatal complications. A follow-up survey will be sent three months post-implementation to assess retention. Statistical analysis included descriptive statistics, F-tests to assess variance, and two-sample t-tests (p<0.05) to compare survey scores.

Eighty-five pre-intervention and 86 post-intervention responses were collected. All 11 survey items demonstrated statistically significant improvement in self-reported confidence and perceived preparedness (p<0.001). Mean confidence and preparedness scores increased for emergency delivery (2.60 to 3.21), neonatal resuscitation (2.34 to 3.23), recognition of neonates requiring resuscitation (2.82 to 3.28), recognition of postpartum hemorrhage (2.76 to 3.28), and understanding of initial neonatal resuscitation steps (2.61 to 3.30). The largest improvements were seen in understanding of the McRoberts maneuver (1.84 to 3.31) and postpartum hemorrhage medications (2.38 to 3.22).

Standardization of equipment and simulation-based education significantly improved self-reported confidence in providing care during emergent delivery and neonatal resuscitation across four small community EDs. This project highlights the importance of equipment standardization coupled with regular in-situ simulation for HALO events.