Background: Heart rate (HR) assessment is a vital component in the neonatal resuscitation (NR) algorithm. Research has consistently found auscultation to be an inaccurate means of assessing neonatal HR and may lead to incorrect resuscitation interventions. Current Neonatal Resuscitation Program (NRP) recommendations include auscultation for initial HR determination. Whether HR assessment via auscultation during NR can be improved with HR-specific training remains unknown. Neonatal HR auscultation training is not currently a part of the NRP curriculum. The purpose of this study is to determine if simulation-based medical education (SBME) can improve pediatric residents’ ability to accurately assess neonatal HRs via auscultation. We hypothesize that a single simulation-based training intervention will improve residents’ ability to assess neonatal HRs.
Methods: The study population includes all pediatric residents at our institution during the study time period. Primary outcomes for this study are HR accuracy and NRP group accuracy, defined as resident ability to assess HR consistent with NRP defined decision-making criteria groups (<60, 60-99, or ≥100 bpm). Pre-intervention assessment: residents estimated 15 HRs on a high fidelity neonatal manikin operated by trained simulation operators. Intervention: residents received a 20-minute, standardized training intervention consisting of didactic review for neonatal HR assessment and simulation skill practice for auscultating HRs on high fidelity manikins. Post-intervention assessment: one month post training, residents repeated the pre-intervention assessment. Results were controlled for year in training and recent delivery room rotations.
Results: HR estimations from 21 pediatric residents showed improved overall HR accuracy from 53.6% to 78.7% (p < 0.0001). These results remained significant when controlling for post-graduate year and recent delivery room exposure. Residents were least accurate when estimating HR >100. Overall NRP group accuracy also improved from 68.3% to 80% (p=0.0002). Subgroup analysis revealed group accuracy increased significantly in HR 60-100 bpm (p=0.001), HR > 100 bpm (p=0.0006), but not in HR < 60 bpm (p=0.56). Group accuracy was lowest when identifying HR < 60 bpm (67%). Residents were more likely to overestimate low HR and underestimate high HR.
Conclusions: HR SBME significantly improved residents’ HR estimation and NRP group accuracy. Providers participating in NRP may benefit by receiving HR skills assessment-focused training during NRP certification. Improving providers’ HR accuracy may lead to more effective NR.