*2.2. SMB*

SMB is a hospital delivering nearly 8000 newborns each year in San Diego. The SMB NICU is a level III 84-bed unit with specialty care including a small baby program, neuro-intensive care program, and an advanced life support team that attends high-risk deliveries. The SMB NICU chose to participate in Simulating Success to address team competencies related to changing patient conditions and to improve communication skills in managing neonatal resuscitations. The team's primary SMART aim was to implement and conduct monthly simulation and debriefing exercises in the NICU at SMB while increasing multidisciplinary participation by the end of the 18 month collaborative. Nursing and respiratory departments added a requirement for each person to participate in at least two simulation and debriefing events per year for their annual performance evaluation. Historically, "mock codes" in this NICU did not focus on behavioral competencies required for improving teamwork, collaboration, and communication. In addition, the team wanted to improve sta ff confidence in managing changing patient conditions including appropriate use of positive pressure ventilation to avoid an unnecessary full resuscitation leading to intubation and/or chest compressions.
