Obstetric Simulation Training and Teamwork (OB-STaT) to Reduce Postpartum Hemorrhage: Short-term Clinical Outcomes (1090-003668) (Research Abstract Oral: Resuscitation)
Start time: Monday, January 25, 2021, 3:30 PM End time: Monday, January 25, 2021, 4:30 PM Session Type: Research Abstracts (Completed Studies)
Pregnancy-related care accounts for 49% of the inpatient care provided to female beneficiaries within the Military Health System(1). Postpartum hemorrhage (PPH) complicates up to 6% of deliveries.2 Simulation training has been show to improve patient outcomes in resuscitation and obstetric emergencies such as shoulder dystocia(3-4). However, minimal evidence is available related to simulation-based obstetric training to improve patient outcomes for PPH(5-7). The objective is to determine the initial impact of the Obstetric Simulation Training and Teamwork (OB-STaT) curriculum on PPH rates, associated clinical outcomes, team performance, and patient satisfaction in U.S. Navy military treatment facilities (MTFs). The investigators hypothesize that OB-STaT, focusing on resiliency, error detection, and error mitigation, will: (a) decrease PPH rates, (b) improve PPH management, (c) improve perceptions of teamwork, (e) improve team performance, and (e) improve overall patient satisfaction.
We conducted an IRB-approved multi-site prospective cohort study. Retrospective chart review was performed to collect baseline PPH rates and clinical outcomes over the 6 months preceding training. A 4-hour interprofessional education (IPE) simulation-based curriculum, OB-STaT, was then implemented at all sites with the goal to train all team members that may respond to an obstetric emergency. Following completion of training, an additional 6 months of clinical data was collected retrospectively for all sites. At the end of each 6 month block of data collection, a random sample of deliveries were observed to evaluate team performance using the Clinical Teamwork Scale (max 150 points) and assess patient satisfaction with the Patient Perception Scale (max 15 points). The change in PPH rates and other clinical outcomes before and after OB-STaT were compared to determine the initial impact of training on patient outcomes.
Analysis included 10,043 deliveries: 5,059 before and 4,984 after OB-STaT. There was no significant difference in mode of delivery or birthweight between the groups. More subjects that delivered after OB-STaT were at risk for PPH (8.7% v 41.7%, p<.001). While the PPH rate did not significantly decrease (5.5% v 5.1%, p=.37), PPH risk factors were associated with a 65% reduction in the likelihood of PPH after training (OR .35, 95% CI .33, .37). Other outcomes related to PPH significantly increased: median (range) uterotonic medication doses (0 (0-6) v 0 (0-8)), tranexamic acid use (2.7% v 4.8%), blood transfusion (27 v 43), and hysterectomy (0 v 5), all p<.05. Length of stay (days) (2.1 v 2.0, p=.04) and composite maternal morbidity (6.2% v 5.2%, p=.03) decreased. No other significant differences were observed in the assessed outcomes. On observed deliveries, patient satisfaction and team performance did not significantly change (14.4 v 14.3 and 93.6 v 99.6, respectively, all p>.05).
Although overall rates of PPH did not significantly decrease, OB-STaT, a standardized IPE simulation-based curriculum, improved PPH management and contributed to decreased length of stay and composite maternal morbidity by increasing doses of uterotonic medications, use of tranexamic acid, blood transfusion, and hysterectomy.