A Novel High Fidelity Multidisciplinary Simulation Exercise to Improve Team Response to Postpartum Hemorrhage [6D

Abstract

INTRODUCTION: Postpartum hemorrhage affects 4-7% of all deliveries, and remains a leading cause of maternal morbidity and mortality. Our goal was to assess provider experience with peripartum hysterectomy and improve team responses with a novel postpartum hemorrhage simulation trainer. METHODS: As part of an ongoing quality improvement project, we conducted a high fidelity multi-disciplinary in situ simulation exercise using a novel operative postpartum hemorrhage trainer with the capability of simulating a peripartum hysterectomy. Participants completed didactic training prior to the simulation. Simulation scenarios included an emergent cesarean delivery followed by a postpartum hemorrhage requiring activation of the massive transfusion protocol, medical and operative interventions including a hysterectomy. Participants were surveyed on their experience and comfort (using a 5-point Likert scale) with managing postpartum hemorrhage and peripartum hysterectomies. RESULTS: We trained 135 participants over 2 days, with 40% nurses, 34% obstetric providers, 14% anesthesia, 10% corpsmen, and 3% emergency medicine. Over 60% of obstetric participants had performed less than or equal to 5 peripartum hysterectomies. Following the simulation exercise, providers reported increased comfort managing postpartum hemorrhage, scores improved by 0.43 points, from 3.64 to 4.08, p = 0.001, 95%CI 0.33-0.54. Providers also reported increased comfort managing peripartum hysterectomies, with scores improved by 0.86 points, from 2.48 to 3.34, p = 0.002, 95%CI 0.7-1.02. CONCLUSION: In conclusion, peripartum hysterectomies are rarely encountered in clinical practice. A high fidelity operative simulator provides a high degree of realism, can be used to teach communication and teamwork, and improves participant comfort in managing peripartum hysterectomies.