754 Brachial plexus injury rate before & after a multi-disciplinary shoulder dystocia simulation program

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Simulation of obstetric emergencies is implemented with the goal of improving clinical outcomes. We sought to assess whether mandatory, multi-disciplinary, department-wide shoulder dystocia simulation training was associated with a change in the rate of brachial plexus injury following shoulder dystocia. This is a retrospective pre-post study comparing brachial plexus injuries before and after implementation of a mandatory, multi-disciplinary simulation curriculum in 2015. All shoulder dystocia cases were identified from a contemporaneous obstetric database and confirmed via chart review. Cases between January 1, 2010 and December 31, 2015 (PRE) were compared with those between January 1, 2016 and December 31, 2019 (POST). The primary outcome was rate of brachial plexus injury. Additional outcomes included any birth injury, NICU admission, and 5 min Apgar ≤ 4. A total of 639 cases of shoulder dystocia were identified. 359 occurred prior to simulation implementation and 280 occurred afterwards. Birth weight, maternal BMI, and number of maneuvers required were similar between the two eras. The composition of delivery providers (between residents, midwives, and attending physicians) was significantly different after the simulation. The rate of brachial plexus injury decreased from 9.8% to 7.1% after simulation implementation, however not statistically significantly so (p = 0.24). 5 minute Apgar ≤ 4 was similar (PRE 1.7% vs. POST 1.8%, p = 0.91). The rate of any birth injury decreased significantly from 22.3% (PRE) to 12.5% (POST, p = 0.001); however, the rate of admission to the NICU increased significantly: 7.0% (PRE) vs. 12.9% (POST, p = 0.012). We found no change in the rate of brachial plexus injury following implementation of shoulder dystocia simulation. There was a decrease in birth injury overall and an increase in NICU admission rate, indicating some association between outcomes and simulation. Further research is needed to understand how to reduce injuries from shoulder dystocia; simulation in and of itself is not a panacea for all adverse obstetric outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)