The Effect of Live and Web-based Training Sessions on the Accuracy of Blood Loss Estimation in Simulated Obstetric Delivery Scenarios
Abstract Number: 3
Abstract Type: Original Research
Introduction: Visual estimation of blood loss has been shown to overestimate small volumes, and underestimate large, clinically significant volumes of blood.(1)The objective of this study was to evaluate the impact of a didactic training program on the accuracy of blood loss estimates and to determine the effectiveness of this training when provided via a web-based session versus a live training.
Methods: Labor and delivery providers participated in this IRB approved, prospective study. There were two training sessions, one live (LT), and one web-based (WT). Providers who did not participate in the LT program completed the WT version. In both sessions, the pretest and post-test consisted of five study stations which were created using materials typically used in a labor and delivery unit. Three small volume stations: laparotomy pad, perineal pad, under the buttocks pad; and two post-partum hemorrhage (PPH) scenarios: vaginal delivery drape and PPH on a bed. Each station had known quantity of blood (range: 75-2000 mL) and the amount was changed between the pre and post-test. Participants estimated the blood loss at each pretest station, completed the didactic session, and finished with a five station post-test. Photographs from the live session were used for the pretest and post-test photos in the WT group. Accuracy was determined as the percent error from the actual volume for each scenario. A P<0.05 was used to reject the null hypothesis.
Results: Prior to training, participants in both LT and WT groups underestimated the blood loss in the larger blood volume scenarios, and overestimated the blood loss in the small volume scenarios. The accuracy of blood loss improved after didactic training in both groups (P<0.001)(fig). In the small blood loss post-test scenarios, the WT group overestimated the blood loss compared to the LT group in the perineal pad and under the buttocks pad scenarios (P<0.01). However, in the PPH scenarios, the WT group underestimated the blood loss in the vaginal delivery drape scenario more than the LT group (P<0.001).
Discussion: The important finding of this study was that didactic training on post-partum hemorrhage and blood loss estimation techniques significantly improved the accuracy of estimated blood loss in clinical scenarios. Our study supports the use of web-based training, although live training appears to be more effective when estimating large volumes.
1. BJOG 2006;113:919-924.