Multidisciplinary In Situ Simulation-Based Training as a Postpartum Hemorrhage Quality Improvement Project.

Area of Science:

• Obstetrics and Gynecology
• Medical Simulation
• Quality Improvement

Background:

• Postpartum hemorrhage (PPH) is a critical obstetric emergency impacting 3-5% of deliveries, associated with significant maternal morbidity and mortality.
• Effective PPH management relies heavily on robust teamwork and interdisciplinary collaboration.
• In situ simulation offers a safe environment to evaluate and enhance clinical protocols and team dynamics.

Purpose of the Study:

• To assess the impact of multidisciplinary in situ simulation training on healthcare professionals' comfort levels in managing obstetric emergencies, particularly PPH.
• To evaluate hospital protocols, team performance, and operational readiness through a simulated PPH scenario.
• To identify opportunities for real-time system improvements in obstetric emergency response.

Main Methods:

• A quality improvement project employing a high-fidelity, multidisciplinary in situ simulation exercise for PPH management.
• 113 healthcare professionals across Obstetrics, Anesthesia, Nursing, Pediatrics, and Transfusion Services participated in 16 simulated scenarios.
• Participant comfort was measured using a 5-point Likert scale before and after the simulation, with paired t-tests analyzing changes. Time to prepare simulated blood products and PPH case frequency were also monitored.

Main Results:

• Participant self-reported comfort significantly increased for managing hypertensive emergencies (4.14 vs. 3.88), shoulder dystocia (4.29 vs. 3.66), and PPH (4.35 vs. 3.86) post-training (p < 0.01 for all).
• A reduction in the time required to prepare simulated blood products was observed during the simulation exercise.
• A decreasing trend in postpartum hemorrhage cases was noted, continuing after the simulation implementation.

Conclusions:

• Multidisciplinary in situ simulation is an effective strategy for enhancing healthcare teams' confidence and competence in managing obstetric emergencies like PPH.
• Simulation training facilitates the identification and improvement of critical hospital protocols, team communication, and system processes.
• This approach is vital for preparing healthcare systems to manage high-stakes, low-volume obstetric events, ultimately improving patient outcomes.