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Checklists and Multidisciplinary Team Performance during Simulated Obstetric Hemorrhage: A Prospective Study
Abstract Number: S-12
Abstract Type: Original Research
Introduction: There is growing appreciation of the importance of simulation and checklists to optimize team performance during medical crises.1,2 However, there is limited data on multidisciplinary team performance in obstetric simulations such as severe postpartum hemorrhage (PPH). Furthermore, the impact of checklists on team performance during obstetric crises has not been previously investigated. In this study, we exposed multidisciplinary teams to checklist training to evaluate team performance and checklist use in a simulation of major PPH post-vaginal delivery.
Methods: Fourteen multidisciplinary teams, consisting of obstetricians, anesthesiologists and nurses, participated in this IRB-exempt study. Based on expert opinion and an ACOG Patient Safety Checklist,3 we developed a 15-point checklist for PPH management. Each team received checklist training prior to the simulation. We recorded individual times taken to complete all 15 tasks on the checklist; administer a 2nd-line uterotonic; activate the massive transfusion guideline (MTG); and start transfusion of red blood cells. We also assessed the frequency of checklist use, and if a ‘checklist reader’ was designated. The participants were unaware of the scenario topic prior to the drill and that interventions were timed.
Results: Data on the times taken to perform critical tasks and the rates of task completion are presented in the Table. The median time taken to activate the MTG was 5.14 [IQR = 3.23-6.43] min. A total of 8/14 (57%) teams completed all the tasks on the checklist within 20 min, and 12/14 (86%) teams used the checklist in each simulation (50% intermittently and 50% extensively). A checklist reader was used by 7/12 (58%) teams. Data did not allow for comparisons between checklist users and non-users.
Discussion: Our results indicate that, despite checklist training prior to a simulation, multidisciplinary teams vary in the scope of checklist use, including the use of a reader. In addition, over 40% teams failed to complete all tasks on the checklist. Although access to checklists may have important value as a management tool during obstetric crises, future research is needed to determine whether better provider education and familiarization would optimize checklist utilization.
References: (1) Anesth Analg 2013;117:1149–61 (2) N Engl J Med 2013;368:246-53 (3) Obstet Gynecol 2013;121:1151–2