In Situ Simulation to Assess the Current State of Cardiac Arrest Care in the Pregnant Patient (1090-002351) (Research Abstract Oral: Simulation Methodology)
Start time: Tuesday, January 26, 2021, 8:00 AM End time: Tuesday, January 26, 2021, 9:00 AM Session Type: Research Abstracts (Completed Studies)
Maternal mortality has been on the rise over the last 15 years. From 2014-2016, in New York, the maternal mortality rate for black women was 51.6 deaths per 100,000 live births, as compared to 15.9 deaths per 100,000 live births for white women over that same period of time. Previous education at New York Health and Hospitals/Elmhurst did not include simulation based training for maternal cardiac arrest. This initiative seeks to assess and improve the current state of maternal cardiac arrest care through in situ based simulations.
19 impromptu, in situ, standardized, code team simulations were conducted on the labor and delivery unit with the actual responding obstetric and hospital code teams in order to allow for systematic assessment of areas of weakness and identification of latent safety threats (LSTs). These were divided into four main categories - equipment, medications, resources/systems, and technical skills. Additionally, participants (n=52) completed the National Aeronautics and Space Administration Task Load Index (NASA-TLX) questionnaire, a multifaceted assessment tool administered post-simulation to rate perceived workload (scale 0-20). This tool allows for assessment of workload domains and distribution among provider types and serves as a surrogate of task, system, and team taskload effectiveness.
NASA Task Load Index: The average score of all participants was 12.51±2.88. Of note, the subcategories of mental demand and temporal demand were particularly high at 15.07±3.90 and 14.50±3.59, respectively. Latent Safety Threat Analysis: 37 unique threats were identified with the most common themes including role assignment and team leader identification, equipment use and location, knowledge deficiencies with regards to defibrillator use, code team activation, and time to perimortem cesarean section.
Using the results of the taskload and LST analysis, a number of improvements were made within the Obstetrics department at Elmhurst. Aimed at reducing the mental workload of healthcare team members, a cognitive aid (sign) was placed above each labor bed reminding providers to perform lateral uterine displacement during CPR. Standardized teaching points have been incorporated into sessions in response to the LST and TLX scores and a review of defibrillator use is completed during each debriefing. In response to the LST and temporal taskload finding that providers had difficulty obtaining a scalpel with sufficient time to perform a perimortem cesarean section by the 4-minute guideline, a system was implemented to stock scalpels in a lock-box inside each patient room. In situ simulation is a powerful tool to assess provider taskload and system threats to ultimately guide education and training as well as equipment allocation and signage, with the goal of improving patient outcomes.