*2.1. CHOC*

The CHOC Neonatal Intensive Care Unit (NICU) is a level IV, 104-bed NICU with a Surgical NICU, Small Baby Unit, Neuro NICU and Cardiac NICU within a free-standing Children's hospital that also has a Pediatric Residency and Neonatal Fellowship program. Participation in Simulating Success was intended to enhance positive team behaviors during neonatal resuscitation that impact patient outcomes. The SMART aims were to (1) increase staff participation in at least one multidisciplinary simulation team

training in the NICU from baseline of 0% to a target of 75% by June 2019; and (2) to improve patient safety through simulation exercises as demonstrated by a decrease in LSTs identified from a baseline of 4.5 per simulation to one over a period of six months, from January to June 2019.

LSTs are improvement goals identified during simulation exercises that have an impact on delivery of optimal care to the patient [14,16,17]. In situ simulations can help identify these knowledge gaps and reinforce positive team behaviors [18]. Knowledge gaps were further categorized as cognitive, technical, or behavioral. The CHOC instructor team used these debriefings to help identify LSTs. The CAPE Real-Time Debriefing Evaluation (DART) tool was used to assess the e ffectiveness of the debriefer(s) and participation of the learners during debriefing (Appendix A). Using the DART tool, a goal ratio of trainee responses to instructor questions plus statements is ideally >3:1. Participants were also asked to submit post-simulation surveys which included 13 questions related to understanding scenario learning objectives, duration and realism of the simulation, facilitators' ability to encourage participation and knowledge base, participants' confidence and psychological safety (Appendix A). The purpose of these were twofold: (1) to ideally increase the value of the program for trainees; and (2) to generate continuous data collection and share it with the Patient Safety Committee and hospital administration to engender support. The data was collected electronically via a QR code and entered into Research Electronic Data Capture (REDCap)—an existing data collection platform used by the hospital.
