Obstetric Simulation Training and Teamwork (OB-STaT): Immediate Impact on Knowledge, Teamwork and Adherence to Hemorrhage Protocols (1090-003669) (Research Abstract Professor Rounds: Group 2)
Start time: Thursday, January 28, 2021, 10:00 AM End time: Thursday, January 28, 2021, 11:00 AM Session Type: Research Abstracts (Completed Studies)
The Obstetric Simulation Training and Teamwork (OB-STaT) curriculum was designed as an in situ Interprofessional Education (IPE) program to provide standardized simulation training throughout a health system. While simulation training has been shown to improve patient outcomes in resuscitation and obstetric emergencies, data on the clinical benefit of postpartum hemorrhage (PPH) training is lacking (1-4). The goal of this program is to decrease PPH rates and improve associated clinical markers by providing training to delivery teams focusing on resiliency, and error detection and mitigation. The investigators hypothesized that OB-STaT would: (a) improve team member knowledge in diagnosis and management of PPH, (b) improve team communication and performance, (c) increase adherence to established PPH protocols, and (d) increase patient satisfaction.
OB-STaT curriculum was implemented at eight participating U.S. Navy military treatment facilities (MTFs) over the course of three to five days with a mobile training team. The in-situ sessions occurred over four hours and included: completion of pretest instruments, two 40-minute scenarios with structured debriefs, and completion of posttest instruments. Participant knowledge was assessed pre- and post-training via an 11-item test related to proper treatment of postpartum hemorrhage and maternal/neonatal resuscitation. Discipline specific proctors (obstetric, nursing, anesthesia, and pediatrics) rated teamwork on the 15-item Clinical Teamwork Scale (CTS) and determined adherence to local PPH protocols via a checklist. Standardized patients provided feedback on the 3-item Patient Perception Score.
We trained 1,049 team members (54 teams), and 399 people (38%) enrolled in the study. Participants included nurses (n=129), pediatric team members (n=43), and providers from obstetrics (n=102), anesthesia (n=47), and family medicine (n=31). Over 70% treated PPH at least twice a year and 59% participated in simulations at least twice a year. Knowledge test scores were similar from pre- to post-training for Anesthesia (8 v 8.07), Family Medicine (8.74 v 8.23), Nursing (7.10 v 7.05), Obstetrics (8.23 v 8.31) and Pediatrics (7.03 v 6.48), all p>.05. CTS scores improved (85.7±20.1 v 106.5± 13.34, p=.008). PPH protocol adherence did not statistically improve (73% v 80%, p>.05), but the teams did reach 80% compliance on the second scenario. Similarly, standardized patient satisfaction did not significantly improve between scenarios (3.52±.77 v 3.73±.72, p=.07), but there was significant improvement noted in feeling well-informed by the medical team (3.40±1 v 3.76±.82, p<.01).
A standardized IPE program is able to improve participant’s ability to communicate and work as a team. Further study is needed to determine if improvements in teamwork can reduce PPH rates and improve clinical outcomes.