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Using simulation to prepare multidisciplinary teams and clinical environments for complex fetal interventions and resuscitation

Journal of Perinatology (2025)Cite this article

Subjects

Abstract

Objective

Identify overt and latent weaknesses in preliminary plans for initiating a Fetoscopic Endoluminal Tracheal Occlusion program.

Study Design

Clinical scenarios involving placement and removal of a fetal tracheal occlusion device for fetuses with severe congenital diaphragmatic hernia were simulated. All sessions took place in the actual hospital environments and were captured on video for later playback, transcription and analysis.

Results

Simulation-based investigation produced: • a list of plausible scenarios • lists of equipment required • diagrams of room setup and positioning of personnel • decision trees for each scenario • situation awareness issues • workflow issues • areas requiring additional planning.

Conclusions

Using appropriate patient simulators and task trainers, teams experienced multiple realistic scenarios that facilitated the development of equipment lists, room setup diagrams, and tactics to remediate identified weaknesses. Simulation is a useful strategy to prepare for the implementation of new, high-risk clinical programs.

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Data availability

All data not included in this manuscript is available to readers upon request to the corresponding author (Dr. Halamek).

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Acknowledgements

The following individuals were instrumental in the planning, setup and conduct of the scenarios: Ana Clark RN, Pamela James RN, Diana Powell MSN RN, Lisa Pineda MSN RN, Sebastian Romero CST, Steven Romero CST. Ms. Pineda also transcribed the audio recordings.

Funding

This work was supported by the Endowment of the Center for Advanced Pediatric and Perinatal Education and the Robert L. Hess Family Endowed Professorship.

Author information

Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, USA

    Louis P. Halamek, Alexis S. Davis, Nicole K. Yamada & Susan R. Hintz

  2. Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics & Gynecology, School of Medicine, Stanford University, Stanford, CA, USA

    Yair J. Blumenfeld

  3. Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Stanford University, Stanford, CA, USA

    Karthik Balikrishnan

  4. Division of Pediatric Surgery, Department of Surgery, School of Medicine, Stanford University, Stanford, CA, USA

    Karl Sylvester

  5. Center for Advanced Pediatric and Perinatal Education, Johnson Center for Pregnancy and Newborn Services, Lucile Packard Children’s Hospital Stanford, Stanford, CA, USA

    Louis P. Halamek, Rodrigo B. Galindo & Nicole K. Yamada

Authors
  1. Louis P. Halamek
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  2. Yair J. Blumenfeld
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  3. Karthik Balikrishnan
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  4. Karl Sylvester
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  5. Rodrigo B. Galindo
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  6. Alexis S. Davis
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  7. Nicole K. Yamada
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  8. Susan R. Hintz
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Contributions

Dr. Halamek wrote the simulated scenarios and led the debriefings that followed. Drs. Halamek, Blumenfeld, Balikrishnan, Sylvester, Davis, Yamada and Hintz participated as key healthcare team members in the conduct of the simulated clinical scenarios and the debriefings that followed; they also contributed to the multiple work products described in the manuscript. Mr. Galindo managed all aspects of the audiovisual recordings, including the secure storage of the same. All authors edited and approved the final content of the manuscript.

Corresponding author

Correspondence to Louis P. Halamek.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

Informed written consent was obtained from all participants. All methods were performed in accordance with relevant guidelines and regulations. Because this work is considered quality improvement IRB approval was waived.

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Halamek, L.P., Blumenfeld, Y.J., Balikrishnan, K. et al. Using simulation to prepare multidisciplinary teams and clinical environments for complex fetal interventions and resuscitation. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02508-6

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