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Reducing Perineal Lacerations Through Team-Based Simulation.

Emily K Marko1, Merlin B Fausett, Shad Deering

  • 1From the Inova Health System (E.K.M., S.S., E.F., G.L.M.), Falls Church, VA; Community Medical Center Missoula Montana (M.B.F.), Missoula, MT; and Uniformed Services University of the Health Sciences (S.D., B.C.S.), Bethesda, MD.

Simulation in Healthcare : Journal of the Society for Simulation in Healthcare
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Summary
This summary is machine-generated.

A simulation-based training program significantly improved labor and delivery teams' knowledge, performance, and safety culture, leading to a 33% reduction in severe perineal lacerations during childbirth.

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Area of Science:

  • Obstetrics and Gynecology
  • Medical Education
  • Patient Safety

Background:

  • Vaginal deliveries can cause perineal trauma and significant maternal morbidity.
  • Strategies exist to reduce the risk of severe perineal lacerations.
  • Evaluating interprofessional simulation-based training is crucial for improving childbirth outcomes.

Purpose of the Study:

  • To assess the effectiveness of an interprofessional simulation-based team training program.
  • To reduce severe perineal lacerations during childbirth.
  • To improve labor and delivery personnel's knowledge, skills, and attitudes.

Main Methods:

  • A quasi-experimental pre-post single-group design was employed.
  • A mixed-modality simulation program trained labor and delivery personnel.
  • Educational strategies included laboring down, warm compresses, coaching, positioning, perineal support, controlled fetal head delivery, and episiotomy techniques.

Main Results:

  • 675 personnel across 4 hospitals participated over 18 months.
  • Significant improvements were observed in knowledge (59.86% to 93.87%), performance (36.54% to 93.45%), and safety culture.
  • Severe perineal laceration rates decreased by 33.38%.

Conclusions:

  • Multimodal interprofessional simulation effectively enhanced knowledge, skills, and attitudes in labor and delivery teams.
  • The simulation program led to a significant reduction in severe perineal lacerations.
  • Continuous education is necessary to maintain improvements, especially with new personnel.