///2010 Abstract Details
2010 Abstract Details2019-08-03T15:49:10-05:00

EFFECT OF TEAM TRAINING ON MANAGEMENT OF OBSTETRICAL EMERGENCIES

Abstract Number: 12
Abstract Type: Original Research

Shivananda Nadiminti MBBS, DA, DNB1 ; Pamela Morgan MD, FRCPC2; Deborah Tregunno RN, PhD3; Richard Pittini MD, FRCSC4; Vicki LeBlanc PhD5; Jordan Tarshis MD, FRCPC6

Introduction: Data from CEMACH and the Joint Commission indicate communication breakdowns as a leading cause of maternal and perinatal morbidity/mortality. Nielsen demonstrated that team training decreased decision to delivery time.1 High-fidelity simulation has been suggested for team training and may improve patient outcomes and safety.

The purpose of this study was to determine if high-fidelity simulation team training improved clinical outcomes of simulated obstetrical emergencies.

Methods: Four obstetrical simulation scenarios were developed; 1) urgent Cesarean section, general anesthesia, "cant intubate, cant ventilate", pulseless electrical activity; 2) severe pre-eclampsia, urgent Cesarean section, pulmonary edema; 3) prolapsed cord, amniotic fluid embolism, asystole; and 4) profound fetal bradycardia, emergency Cesarean section, postpartum hemorrhage. Eighteen clinical outcomes were defined and validated. After REB approval, 12 multidisciplinary teams managed the same 4 scenarios at each of 3 simulation sessions separated by 5-9 months. A trained observer, blinded to subjects and session number, watched the DVDs and recorded the time to resolution of the 18 outcomes. A repeated measures analysis of variance was performed for each outcome measure with session time as the repeated measure.

Results: 34 team encounters accounted for 136 taped performances. Of 34 teams who managed Scenario 1, 14 teams either did not recognize that the patient had arrested and/or did not start chest compressions. In the remaining 20 teams, the average time from maternal cardiac arrest to initiation of chest compressions was 2 minutes 55 seconds (range, 0.4-6.4 mins).

In Scenarios 1 & 3, there was a significant reduction in the time from cardiac arrest to initiation of compressions; in Scenario 2, there was a significant reduction in desaturation to intubation; in Scenarios 1&2, there was a significant decrease in decision to delivery time and in Scenario 3, a significant increase in decision to delivery time. (Figure 1) There were no statistically significant differences in the remaining 12 outcomes.

Discussion: The one finding of a prolonged decision to delivery time was not clinically significant. In 2 scenarios, team training resulted in clinically significant reductions in decision to delivery time similar to that demonstrated by Nielsen. This finding and the improvement in cardiac arrest management may result in a less compromised neonate at birth.

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SOAP 2010