Obstetric Simulation Training and Teamwork: Immediate Impact on Knowledge, Teamwork, and Adherence to Hemorrhage Protocols
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Published on: May 20, 2018
Joy A Greer1, Monica A Lutgendorf, Christopher S Ennen
1From the Healthcare Simulation and Bioskills Training Center (J.A.G., L.V.P., A.M., D.R.D.), and Department of Gynecologic Surgery and Obstetrics, Naval Medical Center, Portsmouth, VA (J.A.G., C.S.E.); Department of Gynecologic Surgery and Obstetrics (J.A.G., M.A.L.), Uniformed Services University of Health Sciences, Bethesda, MD; Department of Gynecologic Surgery and Obstetrics (M.A.L., D.S., J.F.), Naval Medical Center, San Diego, CA; Department of Anesthesia, Naval Medical Center, Portsmouth, VA (R.M.); and Bioskills (C.N.S.), Simulation Training Center, Naval Medical Center, San Diego, CA.
Introduction:
The Obstetric Simulation Training and Teamwork (OB-STaT) curriculum was an in situ interprofessional program to provide standardized postpartum hemorrhage (PPH) simulation training throughout a health system to decrease PPH morbidity. In this study portion, investigators hypothesized that OB-STaT would increase: (a) team member knowledge in diagnosis and management of PPH, (b) teamwork, (c) adherence to established PPH protocols, and (d) patient satisfaction.
Methods:
The OB-STaT was implemented at 8 US Navy hospitals between February 2018 and November 2019. Participant PPH treatment and maternal/neonatal resuscitation pretraining/posttraining knowledge was assessed via an 11-item test, whereas teamwork and standardized patient assessment were rated using validated Likert-type scales: the 15-item Clinical Teamwork Scale and 3-item Patient Perception Score, with item ranges of 0 to 10 and 0 to 5, respectively. Local PPH protocol adherence was assessed using role-specific checklists, with a potential maximum of 14 points (anesthesia/nursing) or 22 points (obstetrics).
Results:
Fifty-four interprofessional teams participated. Obstetricians (trainees and attendings) demonstrated significantly improved knowledge test scores (8.33 ± 1.6 vs. 8.66 ± 1.5, P < 0.01). Between the 2 scenarios, overall mean Clinical Teamwork Scale scores improved significantly for all interprofessional teams (5.82 ± 2.0 vs. 7.25 ± 1.9, P < 0.01). Anesthesia, nursing, and obstetric subteams demonstrated significant increases in protocol adherence as measured by critical action scores (12.28 ± 1.7 vs. 13.56 ± 1.0, 12.43 ± 1.6 vs. 13.14 ± 1.3, and 18.14 ± 2.7 vs. 19.56 ± 2.1 respectively, all P < 0.02). Although overall standardized patient satisfaction did not significantly improve, scores for feeling well informed did (3.36 ± 1.0 vs. 3.76 ± 0.8, P < 0.01).
Conclusions:
The OB-STaT curriculum modestly improved participants' teamwork, communication, and protocol adherence during simulated PPH scenarios; OB-STaT may decrease PPH morbidity.
