{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T06:03:30Z","timestamp":1785477810666,"version":"3.56.0"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2023,7,1]],"date-time":"2023-07-01T00:00:00Z","timestamp":1688169600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Patient safety is a major concern in medicine. Approximately, 4 million infants die each year worldwide and 23% of these deaths are caused by perinatal asphyxia. To prevent the long-term damage of asphyxia, the resuscitation flowchart must be perfectly and promptly performed. However, high effectiveness in performing resuscitation can only be achieved and maintained if the algorithm is frequently executed. Therefore, maintaining a high level of patient care is difficult in some remote centres. The aim of this study was to evaluate the effectiveness of a new organizational model of care-network between Hub &amp; Spoke hospitals to improve both the safety of the newborns in hospitals with a low number of births and the well-being of operators. Our project, NEO-SAFE (NEOnatal SAFety and training Elba), began in 2017 and involved the neonatal intensive care unit and the NINA Center of the Pisa University Hospital (hub) and the Hospital of Elba Island (spoke). It consisted of a continuous training program, both with \u2018classic\u2019 training course and \u2018on-job tutoring\u2019 (on side and remotely), of the health workers at spoke (i.e. nurses, midwives, and paediatricians). All four milestones of the study design were achieved. During the project, NINA Center instructors organized training courses for the staff in Portoferraio. These courses were based on learning technical and non-technical skills in a training course of increasing difficulty. Staff training needs were also monitored during the project by means of periodic questionnaires, sentinel events, and specific requests. The curve described by the rate of newborns transfer to the Pisa neonatal intensive care unit (hub) shows a monotonous decreasing trend line. On the other hand, this project allowed operators to develop greater self-confidence and greater safety in managing emergency situations, reducing stress for them and improving patient safety. The project allowed the creation of a safe, effective, low-cost, and reproducible organizational model for centres with a low number of births. Moreover, the tele-medicine approach is an important improvement in the assistance and is a window on the future.<\/jats:p>","DOI":"10.1093\/intqhc\/mzad045","type":"journal-article","created":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T19:31:20Z","timestamp":1688585480000},"source":"Crossref","is-referenced-by-count":1,"title":["NEO-SAFE: a clinical model for\u00a0patients and\u00a0healthcare personnel safety in\u00a0primary level hospitals"],"prefix":"10.1093","volume":"35","author":[{"given":"Federica","family":"Cetica","sequence":"first","affiliation":[{"name":"Area Materno-Infantile, Presidio Ospedaliero di Portoferraio\u2014Azienda USL Toscana Nord Ovest , Via S. Rocco, Portoferraio, LI 57037, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Ciantelli","sequence":"additional","affiliation":[{"name":"UO Neonatologia, Azienda Ospedaliero Universitaria Pisana , via Roma 67, Pisa, PI 56127, Italy"},{"name":"Centro di Formazione e Simulazione Neonatale NINA, Azienda Ospedaliero Universitaria Pisana , via Roma 67, Pisa, PI 56127, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Carcione","sequence":"additional","affiliation":[{"name":"Area Materno-Infantile, Presidio Ospedaliero di Portoferraio\u2014Azienda USL Toscana Nord Ovest , Via S. Rocco, Portoferraio, LI 57037, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1765-1972","authenticated-orcid":false,"given":"Rosa T","family":"Scaramuzzo","sequence":"additional","affiliation":[{"name":"UO Neonatologia, Azienda Ospedaliero Universitaria Pisana , via Roma 67, Pisa, PI 56127, Italy"},{"name":"Centro di Formazione e Simulazione Neonatale NINA, Azienda Ospedaliero Universitaria Pisana , via Roma 67, Pisa, PI 56127, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugo","family":"Bottone","sequence":"additional","affiliation":[{"name":"Dipartimento Materno-Infantile, Azienda USL Toscana Nord Ovest , Via Antonio Cocchi, 7\/9, Pisa, PI 56121, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Pellegrini","sequence":"additional","affiliation":[{"name":"Area Materno-Infantile, Presidio Ospedaliero di Portoferraio\u2014Azienda USL Toscana Nord Ovest , Via S. Rocco, Portoferraio, LI 57037, Italy"},{"name":"UO Ostetricia e Ginecologia, Ospedale di Empoli\u2014Azienda USL Toscana Centro , Viale Giovanni Boccaccio, 16\/20, Empoli, FI 50053, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debora","family":"Caiazzo","sequence":"additional","affiliation":[{"name":"Area Materno-Infantile, Presidio Ospedaliero di Portoferraio\u2014Azienda USL Toscana Nord Ovest , Via S. Rocco, Portoferraio, LI 57037, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Gagliardi","sequence":"additional","affiliation":[{"name":"Dipartimento Materno-Infantile, Azienda USL Toscana Nord Ovest , Via Antonio Cocchi, 7\/9, Pisa, PI 56121, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cinzia","family":"Luzi","sequence":"additional","affiliation":[{"name":"UOC Professione Ostetrica, Azienda USL Toscana Nord Ovest , Via Antonio Cocchi, 7\/9, Pisa, PI 56121, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Lenzini","sequence":"additional","affiliation":[{"name":"Dipartimento Infermieristico e Ostetrico, Azienda USL Toscana Nord Ovest , Via Antonio Cocchi, 7\/9, Pisa, PI 56121, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Bardelli","sequence":"additional","affiliation":[{"name":"Centro di Formazione e Simulazione Neonatale NINA, Azienda 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