BackgroundInter-professional teamwork is key for patient safety and team training is an effective strategy to improve patient outcome. In-situ simulation is a relatively new strategy with emerging efficacy, but best practices for the design, delivery and implementation have yet to be evaluated. Our aim is to describe and evaluate the implementation of an inter-professional in-situ simulated team and resuscitation training in a teaching hospital with a programmatic approach.MethodsWe designed and implemented a team and resuscitation training program according to Kern’s six steps approach for curriculum development. General and specific needs assessments were conducted as independent cross-sectional surveys. Teamwork, technical skills and detection of latent safety threats were defined as specific objectives. Inter-professional in-situ simulation was used as educational strategy. The training was embedded within the workdays of participants and implemented in our highest acuity wards (emergency department, intensive care unit, intermediate care unit). Self-perceived impact and self-efficacy were sampled with an anonymous evaluation questionnaire after every simulated training session. Assessment of team performance was done with the team-based self-assessment tool TeamMonitor applying Van der Vleuten’s conceptual framework of longitudinal evaluation after experienced real events. Latent safety threats were reported during training sessions and after experienced real events.ResultsThe general and specific needs assessments clearly identified the problems, revealed specific training needs and assisted with stakeholder engagement. Ninety-five interdisciplinary staff members of the Children’s Hospital participated in 20 in-situ simulated training sessions within 2 years. Participant feedback showed a high effect and acceptance of training with reference to self-perceived impact and self-efficacy. Thirty-five team members experiencing 8 real critical events assessed team performance with TeamMonitor. Team performance assessment with TeamMonitor was feasible and identified specific areas to target future team training sessions. Training sessions as well as experienced real events revealed important latent safety threats that directed system changes.ConclusionsThe programmatic approach of Kern's six steps for curriculum development helped to overcome barriers of design, implementation and assessment of an in-situ team and resuscitation training program. This approach may help improve effectiveness and impact of an in-situ simulated training program.

Introduction: Neonatal hydrocephalus requires early recognition and appropriate surgical management to prevent long term sequalae. Definitive surgical management includes cerebrospinal fluid (CSF) diversion through a CSF shunt insertion, or neuro-endoscopic third ventriculostomy with or without choroid plexus cauterization. Surgical decision-making and the chosen approach are based on patient age, etiology, imaging, and comorbidities. Endoscopic third ventriculostomy (ETV) has been proven to provide a reasonable treatment option for hydrocephalus in children under 12 months of age. To our knowledge we report for the first time the application of indocyanine green fluorescence imaging to visualize the basilar artery during an ETV to prevent from harming the vessel. Patients and methods: A 7mo old patient with a history of preterm delivery at 27 weeks of gestation and intraventricular bleeding grade 2 developed consecutive hydrocephalus due to aqueductal obstruction. Indication was made for ETV. Results: ETV was carried out. During the procedure indocyanine green was applied to visualize the basilar artery prior to opening the floor of the third ventricle. This provided the surgical team with a clear picture of the anatomy thus enabling ETV while safely sparing the basilar artery. Discussion: ETV in infants are demanding procedures. The risk of harming the basilar artery is immanent as the vessel with its known anatomical variants cannot be clearly visualized through the floor of the third ventricle. With the application of indocyanine green fluorescence imaging this can be overcome providing an increased safety during the actual ETV. To our knowledge this is the first report on the use of indocyanine green fluorescence imaging for pediatric ETV. It might offer a new range of safety while providing minimal invasive neuro-endoscopic procedures to infant patients.