title: Implementing a Neonatal Transport System With Simulation in Kosovo.
abstract: OBJECTIVE
  Post-war Kosovar health care systems have reduced gaps in maternal and newborn health care. Coordinated neonatal transport programs may further improve survival and morbidities.
  
  
  METHODS
  Transport care paradigms were tested using in situ (Kosovo) and ex situ (the United States) mobile immersive simulation. Patient demographics and outcomes were measured at the tertiary referral center.
  
  
  RESULTS
  Four paired physician and nurse transport teams performed 7 simulated interfacility transports across Kosovo. In situ simulations revealed safety threats in facilities, ambulances, and team process. Ex situ observations reinforced roles and professionalism. For the first year after simulations, tertiary neonatal intensive care unit admissions were more premature (-2.4 weeks), smaller (-725 g), and out born (+12%). Mortality was higher (14.7% vs. 7.8%), hypothermia was lower (0.2% vs. 4.6%), and culture-positive sepsis was lower (15.7% vs. 42.9%).
  
  
  CONCLUSIONS
  In situ augmented by ex situ simulation provided perspective and depth of understanding to implement a new care delivery paradigm. Simulations involving Kosovar health care providers across a network of facilities generated practical experience in nationwide neonatal transport, with temporal association to altered referral patterns at the tertiary care facility.
authors.affiliation: Women & Infants' Hospital, Providence, RI, USA; Alpert Medical School at Brown University, Providence, RI, USA. Electronic address: gbender@wihri.org.
authors.forename: G Jesse
authors.initials: GJ
authors.lastname: Bender
authors.affiliation: Women & Infants' Hospital, Providence, RI, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Kennally
mesh_terms: D017732:Air Ambulances / Q000458:organization & administration; D003198:Computer Simulation; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000379:methods / Q000458:organization & administration*; D063826:Kosovo; D008297:Male; D014187:Transportation of Patients / Q000379:methods / Q000458:organization & administration*