Impact of simulation and team training on postpartum hemorrhage management in non-academic centers

ABSTRACT

Objective: Prompt recognition and response to postpartum hemorrhage (PPH) are vital in preventing maternal morbidity and mortality. We conducted a multi-center study to evaluate in situ simulation and team training for PPH among experienced clinical teams in non-academic hospitals in urban and rural communities.

Methods: A longitudinal intervention study was performed in six Oregon community hospitals. All teams responded to an in situ simulated delivery and postpartum hemorrhage using trained actors and an obstetric birthing simulator, followed by a debriefing and training session. The simulation scenario was then repeated in 9–12 months. All sessions were digitally video recorded and independently reviewed by two obstetricians using a structured evaluation form. PPH management including clinical response times were compared before and after team training using Student’s paired t-test and McNemar’s test.

Results: Twenty-two teams completed paired case simulations. Team training significantly improved response times in the management of PPH, including the recognition of PPH, time to administer first medication, performance of uterine massage and time to administer second medication. Medical management (use of three indicated medications) improved after training from 27.3% to 63.6%, p = 0.01.

Conclusions: Simulation and team training significantly improved postpartum hemorrhage response times among clinically experienced community labor and delivery teams.

• Clinical competence
• education
• outcome and process assessment
• patient care team
• postpartum hemorrhage
• pregnancy complications
• simulation

Acknowledgements

The authors would like to recognize Hong Li, MD, MSPH for her assistance with statistical analysis.

Declaration of interest

The authors report no declarations of interest. This work was funded by the Agency for Healthcare Research and Quality, Grant No. U18 HS015800-01. This article was presented in part at the American College of Obstetricians and Gynecologists Annual Clinical Meeting in Chicago, Illinois, 2–6 May 2009.