Developing simulation-based training programme for preterm births

Summary 

Preterm birth is a leading cause of neonatal mortality and long-term morbidity. PREM7+ is the South East region’s perinatal optimisation care bundle. As part of this, to improve outcomes for preterm infants, a multidisciplinary simulation-based training programme was developed to support perinatal teams across Kent, Surrey, and Sussex (KSS). The programme focussed on two key interventions, Optimal Cord Management (OCM) and normothermia (temperature management), and aims to improve adherence to evidence-based practices, enhance perinatal teamwork, and reduce variation in care. Through collaborative design, pilot testing, and feedback-driven refinement, the training has demonstrated improved engagement, knowledge transfer, and potential for wider adoption across the region. This case study describes the results of the successful Sussex pilot which has informed the overarching training programme. 

Challenge 

Globally, preterm birth accounts for 35% of neonatal deaths and 18% of deaths in children under five. In KSS, 824 infants were born below 34 weeks in 2024, 121 of these born before 27 weeks. The Health Innovation Networks’ Patient Safety Collaborative maternity and neonatal commission is aligned to the NHS ambition to reduce preterm births from 8% to 6%. Despite strong evidence supporting OCM and normothermia, adherence across KSS varied significantly – from 50% to 96% for OCM and 63% to 80% for normothermia. Simulation-based education (SBE) was identified as a suitable method to improve consistency and confidence in delivering these interventions, particularly in high-pressure, multidisciplinary settings like obstetric theatres.  

Approach 

The training programme was co-designed with Ashford and St Peter’s Hospitals (ASPH), University Hospitals Sussex, Sussex Local Maternity & Neonatal System and Sussex University. It followed the British Association of Perinatal Medicine (BAPM) frameworks and toolkits for OCM and normothermia. Two pilot “Dry Run” simulation events were held at the Royal Sussex County Hospital (RSCH): 

• Dry Run 1 was carried out with 22 staff members from RSCH and East Sussex Healthcare NHS Trust, supported by ASPH, and through the pilot challenges in scenario flow and team expectations were revealed, prompting a redesign of the training. 

• Dry Run 2 included 16 staff members and featured simplified, structured scenarios with increased realism and broader staff representation, resulting in more effective learning and positive feedback. 

The training scenarios were designed to be inclusive, using diverse mannequins and addressing disparities in outcomes for marginalised communities. 

Impact 

The programme team have now developed an improved scenario design based on feedback from 38 staff across two pilot events. Positive feedback was provided from participants, with one noting: “We are here to give the smallest humans the best possible chance.” 

Tricia Rigby, Head of Clinical Education and Practice Development for Nursing and Midwifery at University Hospitals Sussex, said: “I am so excited that University Hospitals Sussex is part of this wonderful project which supports clinicians to work within a psychologically safe environment, ensuring everyone has a voice and human factors is encompassed, working with maternal and neonatal voice partners and patient feedback for co-production and design.”   

Spread and Scalability 

Filming of the finalised scenarios is underway, with plans to make the training package freely available across all 13 KSS trusts. The project has also informed ongoing research into healthcare inequalities and optimisation practices, with support from NHS England South East and academic partners. 

Find Out More 

• Building Successful Perinatal Teams 

• Optimal Cord Management Toolkit 

• Normothermia Toolkit 

For more information, contact Rachael Garrett, Programme Manager for maternity and neonatal projects: rachaelgarrett@nhs.net