Optimizing Frontline Networking Between Consultant-Led Neonatal Teams in the West Midlands: A Qualitative Report on the Utility of Modified Simulation Training. 

Abstract

Background: In England neonatal care is delivered within operational delivery networks. Units within these networks are one of three designations (Neonatal Intensive Care, Local-Neonatal or Special-Care Units), based on their ability to care for babies with different degrees of illness or prematurity. With the development of network care-pathways, the most premature and sickest are triaged where possible for delivery in services linked to Neonatal Intensive Care units. This has created anxiety for teams in Local-Neonatal and Special-Care units. Less exposure to sicker babies meant limited opportunities to maintain expertise for when they do unexpectedly deliver at services linked to their own units, and thereafter require transfer for ongoing care, to Neonatal Intensive Care units. Simultaneously, Local-Neonatal and Special-Care teams develop skills in care of the less ill and premature baby which was considered of benefit to all. A need for mutual learning through networking between teams of different designations emerged.Method: An interactive programme, ‘Supporting The Sick Neonate’ was developed in the West Midlands. It focused on equal partnership between unit designations, employing high, medium and low fidelity simulation as the vehicle around which networking between units was centered. Sessions of simulation and debrief were augmented with novel networking time to enable multidirectional learning and understanding of practices. Candidates and facilitators were regarded as participants, spanning different designations. A consultant-focus was adopted to promote long term networking. Qualitative assessment of the programme over four years was captured through -graded and free text surveys.Results: 155 individuals involved in frontline neonatal care participated. 77 were consultants, supported by neonatal trainees, staff grade doctors, clinical fellows, advanced neonatal nurse practitioners and nurses in training. All were invited to participate in the qualitative survey. 79% felt that it was highly relevant; 96% agreed that for consultants this was appropriate adult learning. 98% agreed that consultant training encompassed more than bedside clinical management, including forging communication links between teams. Thematic responses around networking were positive.Conclusion: Simulation augmented with networking time with a consultant-focused model proved successful for networking and shared learning for the Neonatal fraternity in the West Midlands.