RSU Study: Improving Paediatric Intensive Care Skills Using Simulation Methods

Rīga Stradiņš University (RSU) started a research project at the end of January 2020 with the aim to use simulations to upgrade the resuscitation skills of doctors and nurses in the Neonatal Intensive Care Unit at the Children’s Clinical University Hospital (CCUH). The study is headed by Reinis Balmaks, Assistant Professor at the RSU Medical Education and Technology Centre (METC) Department of Clinical Skills and Medical Technologies and a doctor at CCUH. Balmaks has vast experience in organising simulations in both Latvia and internationally.

Asst. Prof. Balmaks uses an analogy to explain the significance of simulations: ‘You can compare resuscitation to sports – the more you exercise and practice, the better your results. If you have read a book on football and theoretically know the rules, but have never played the game, there is no way you can succeed. It’s the same with resuscitation – if you have acquired the theoretical knowledge, but have failed to train and test your practical skills, they are weak and might get worse over time, or even disappear. Regular training for professional doctors ensures that they maintain and upgrade their qualifications and skills. This leads to improved patient safety.’

The participants of the new project are split into several teams and take part in simulation-based training once a month in a real-life setting at the hospital. The training will last for five months. Each participant has a different role on the team. Medications, equipment, respiratory devices and other equipment are used during simulations. According to Asst. Prof. Balmaks, ‘everything resembles real-life circumstances except having a real patient’.

The research project is expected to have several outcomes. One of them is purely practical – to acquire additional skills. The other outcome is more research-oriented – to detect whether these additional skills actually help saving young patients and whether the team operates more efficiently. The evaluation takes place using a specifically developed scenario and a test that allows for an analysis of patient data at neonatal care units. It also allows for an evaluation of the duration of patients’ stay in intensive care units for patients who are being treated for slow heart rate (bradycardia) and low oxygen supply (hypoxia). Doctors benefit from participating in this project as they improve their knowledge about oxygen deficiency, which is a life-threatening condition for newborns.

According to Asst. Prof. Balmaks every life-threatening condition has two characteristic features – frequency, and the level of risk. If a complication does not occur frequently, even if it can lead to death, we still have to be prepared. This is also the case with simulation training, where, for example, hypoxia is not common in newborns, but the consequences can even be severe.

The aforementioned study was made possible thanks to funding obtained through a competition organised by the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) and through the active support of the RSU METC. ‘ESPNIC is the leading professional organisation in this field in Europe. Its mission is to promote and strengthen the provision of high-quality care of critically ill children, including newborns. The organisation is dedicated to introducing new methods and technologies in paediatric treatment, upgrading medical practitioners’ qualifications, promoting research and cooperation between professionals of the field, clinics and educational institutions,’ says Balmaks, who is the project leader. He adds that ESPNIC holds conferences, seminars and sets the standards for neonatal intensive care.

Last year ESPNIC announced a research project competition for its members for the first time. Asst. Prof. Balmaks has been a member of the organisation since 2015 and was among the lucky few participants whose applications were ranked high, and he received funding. Balmaks stresses, however, that this success is the result of major involvement and assistance provided by the RSU METC in implementing intensive care simulation.