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SIMULATED INTERPROFESSIONAL TEAM TRAINING FOR OBSTETRIC EMERGENCIES OUTSIDE OF THE LABOR AND DELIVERY UNIT: UNCOVERING HIDDEN ERRORS
Abstract Number: SAT-20
Abstract Type: Original Research
Integrating medical simulation into interprofessional (IP) provider education can improve responses to medical crisesand uncover latent systems errors. Obstetric (OB) emergencies that require transporting a maternal patient between floors require highly complex team coordination. Despite having a robust institutional labor and delivery (L&D) care model and culture, with anesthesia providers seemingly well-integrated into OB care decisions, OB emergencies occuring outside of L&D require coordinating care through unfamiliar pathways and communication systems. We sought to test our system for latent errors using both a focus group approach to uncover healthcare members’ mental models, and in situ IP simulation using a simulated antepartum (AP) patient who develops an acute cord prolapse. We chose this combination to understand how providers in all role groups approach this emergency, both from a theoretical as well as an actual management standpoint.
This study was approved by IRB. We held focus groups using a semi-structured interview approach, followed by high-fidelity IP team training simulations and debriefings facilitated by experienced simulation instructors. Six focus groups were held according to role, and each consisted of either three RNs or three physician providers. The RN groups were made up of RNs from AP, postpartum, and L&D units. The physician focus groups contained OB/GYN generalists, maternal fetal medicine specialists, and anesthesia attendings. These transcripts were reviewed by two independent reviewers (EC, RDM). Seven IP team training simulations were conducted in situ with a simulated AP patient with fetal umbilical cord prolapse. Each simulation included two obstetric providers, two resource RNs, two staff RNs and one obstetric anesthesia attending, which paralleled typical OB care provider coverage. Each IP team training scenario was immediately followed by a debriefing.
In focus group discussions of ideal management, all groups highlighted immediate transport to the operating room (OR) for emergent cesarean delivery. None of the groups highlighted notifying the OB anesthesia team during discussion despite universal agreement that the patient needed an emergent anesthestic. Simulations and debriefings highlighted challenges in transporting the patient to the OR, as well as having key team members present, with no standardized approach to alerting the anesthesia team. All groups noted challenges entering the L&D unit OR due to lack of standardized access.
Discussion: When faced with a simulated OB cord prolapse, our OB IP providers’ care and communication differed from their mental models of ideal management, and they faced hidden challenges in coordinating care. This included physical transport of the patient to the OR, and uniformly including anesthesia providers. Addressing these through uniform processes may help support providers who care for maternal patients transported to L&D.