Simulation-based development: shaping clinical procedures for extra-uterine life support technology

Abstract

Background Research into Artificial Placenta and Artificial Womb (APAW) technology for extremely premature infants (born < 28 weeks of gestation) is currently being conducted in animal studies and shows promising results. Because of the unprecedented nature of a potential treatment and the high-risk and low incidence of occurrence, translation to the human condition is a complex task. Consequently, the obstetric procedure, the act of transferring the infant from the pregnant woman to the APAW system, has not yet been established for human patients. The use of simulation-based user-centered development allows for a safe environment in which protocols and devices can be conceptualized and tested. Our aim is to use participatory design principles in a simulation context, to gain and integrate the user perspectives in the early design phase of a protocol for this novel procedure. Methods Simulation protocols and prototypes were developed using an iterative participatory design approach; usability testing, including general and task-specific feedback, was obtained from participants with clinical expertise from a range of disciplines. The procedure made use of fetal and maternal manikins and included animations and protocol task cards. Results Physical simulation with the active participation of clinicians led to the diffusion of tacit knowledge and an iteratively formed shared understanding of the requirements and values that needed to be implemented in the procedure. At each sequel, participant input was translated into simulation protocols and design adjustments. Conclusion This work demonstrates that simulation-based participatory design can aid in shaping the future of clinical procedure and product development and rehearsing future implementation with healthcare professionals.

Transferring an extremely premature infant to an extra-uterine life support system: a prospective view on the obstetric procedure

“…Research suggests that medical simulation may improve obstetric team performance and maternal and perinatal outcomes ( 184 ). Medical simulation has also been proposed within an APAW context to complement the development of procedures tailored to human patients ( 5 , 155 , 185 ). Although in silico studies should ultimately be followed by validation in vivo , the emergence of novel simulation technologies could offer an intermediary step that allows for a controlled and safe environment for procedural development and training.…”