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A Pilot Study of a High-Fidelity, Low-Cost, and Simulation-Based Educational Intervention to Improve Obstetric Patient Safety and Teamwork in China
Abstract Number: F-20
Abstract Type: Original Research
Introduction: Simulation (SIM) is an educational tool that can help optimize crisis management.  We carried out inexpensive in-situ SIM training in China with the goal of improving interdisciplinary team performance in obstetric (OB) emergencies.
Methods: Four teams of Chinese obstetricians, anesthesiologists, midwives and nurses participated in two consecutive SIMs: STAT Cesarean delivery and post-partum hemorrhage. The SIMs were performed in real labor and operating rooms. A volunteer played the patient, but invasive procedures were acted out. Rudimentary SIM materials were: intubatable head, newborn doll, fake blood (tomato sauce), iPad, and the DART Sim™ app. After each SIM, participants reflected on their teamwork in facilitated debriefings. SIMs and debriefings were videotaped and reviewed. Latent errors were identified, and time stamps for “decision” (calling an emergent surgery) and “incision” were extracted to calculate “decision to incision” (DTI) time. Debriefings were analyzed for themes and opportunities for future research.
Results: Six of eight SIMs had complete data. The shortest DTI time was 4:44 (minutes:seconds), the longest was 7:48. Teams 1 and 3 improved DTI times between SIMs by 1:53 and 1:23, respectively. All participants enjoyed the SIMs and learned something that would change future practice. Identified latent errors included unsafe patient transfer, equipment blocking hallways, and lack of immediately available medications or equipment. Identified areas for improvement included team communication, role clarity, and parallel processing of urgent tasks.
Discussion: In this pilot feasibility study, OB emergency SIM training with rudimentary equipment was successful. Improved performance may be attributed to deliberate practice and “just-in-time training” to identify barriers to management. Limitations include a small N and differences in clinical implications between the two SIMs. Strengths include in-situ inter-professional training, deliberate assessment of learners’ needs and rapid-cycle practice after a facilitated debriefing. Further studies are planned to study how low-cost SIMs can be used as an educational tool for improving team performance.
Dr. Lingqun Hu (No Pain Labor & Delivery Program)
MGH Center for Global Health
1. Merien et al. Multidisciplinary team training in a simulation setting for acute obstetric emergencies: a systematic review. Obstet Gynecol. 2010 May;115(5):1021-31