Board #306 - Technology Innovation Modifications to the SimMan3G Advanced Patient Simulator for a High-fidelity Postpartum Hemorrhage Team-based Scenario (Submission #8851)

Abstract

Introduction The goal of this project was to extend the SimMan3G Advanced Patient Simulator capabilities to include postpartum hemorrhaging suitable for high-fidelity obstetric team based simulation. The female genitalia supplied with SimMan3G, while useful for providing visual indicators of gender and functionality for urinary catheterization, currently lack appropriate fidelity to facilitate detailed gynecological assessment and functionality for postpartum hemorrhage. The scenario utilized a stock SimMan3G with the following additional capabilities: A “boggy” uterus, detailed vaginal anatomy w/ 4th degree labral tear (partially repaired), active and controllable hemorrhaging, retained placental pieces, while retaining urinary catheter functionality. This model was designed to be used in conjunction with a custom designed postpartum simulation scenario for a multidisciplinary team involving physicians, nurses, secretaries, and other allied health disciplines. The simulation is part of a larger curriculum that focuses on closed loop communication using the TeamSTEPPS model and process improvement. Description A SimMan3G was retrofitted with a modified Simulab episiotomy trainer. The episiotomy trainer was modified to have hemorrhaging capabilities by inserting IV tubing from the posterior aspect of the vagina and securing the open end to the base of the internal portion of the labral tear. The exterior of the episiotomy trainer was sutured to approximate the edges of the tear; however, the internal portion of the tear was left open for discovery by the resident or physician. This allowed for pooling of the blood in the posterior portion of the vagina and also allowed noticeable hemorrhaging from the vaginal introitus. Red Jello, saturated cotton balls, and fake blood moulage were used to simulated pieces of placenta and blood clots. A chest skin from an old SimMan was placed upside-down over the abdomen covering a partially inflated IV bag with IV tubing connected to a 50cc syringe to simulate a boggy uterus. Polystyrene batting was packed around the IV bag to both secure it in place and to replicate the shape and feel of a recent postpartum female abdomen. The firmness of the uterus can be adjusted by adding or removing air with the syringe. The SimMan3G was programmed using a simple temporal trend of vital signs to represent acute blood loss for the duration of the scenario. Conclusion The postpartum hemorrhage model was constructed over a period of one week and tested for required functionality. The completed model was successfully deployed and tested with the simulation scenario for a postpartum/labor and delivery multi-department in-situ training session. The model worked as intended. Initial anecdotal reviews had favorable responses. The participants did not require additional familiarization with the model. Future research will include assessing if the participants in the postpartum hemorrhage simulation scenario improved competency and ultimately if this reflects in an improvement in clinical patient outcomes. Disclosures None