Board 373 - Research Abstract High-Fidelity Simulation Results in Improvement of Clinicians Performance in the Management of Massive Hemorrhage Cases (Submission #64)

Abstract

Introduction/Background A massive haemorrhage can be a rare but serious complication of paediatric trauma and obstetrical cases. In order to optimize the management of massive haemorrhages, a protocol was implemented at our centre. However, recent audits showed that necessary improvements were to be made to many aspects of its application. Our objective was to evaluate the application of a massive hemorrhage protocol and the ability to work in interdisciplinary teams using simulation and targeted training. We also aimed to evaluate confidence levels of different team members to apply the protocol and to hold their role in an interdisciplinary team during a crisis situation. Methods Prospective observational study held at the simulation lab and at the blood bank of a tertiary mother-child health care facility in 2012. Participants were nurses, respiratory therapists, orderlies, anesthetists, obstetricians, pediatric emergency physicians, intensivists and hematologists, as well as blood bank technologists. Pediatric emergency/intensive care and obstetrical/anesthesia teams were submitted to high-fidelity (HF) simulated pediatric trauma and post-partum massive hemorrhage scenarios respectively (SimbabyTM (Laerdal) and NoelleTM (Gaumard)). Blood bank technologists were videotaped and telephone conversations between them and participants at the simulation lab were recorded for review. If hematologists were consulted, they were called back by the blood bank chief technologist and asked to answer questions relevant to the application of the massive hemorrhage protocol (MHP). Each participant was asked to hold their usual role in an interdisciplinary team. Scenarios were developed, programmed and run by experts in each field. Targeted training consisted of a debriefing session and a presentation reviewing the MHP and teamwork skills. Documents on MHP, as well as a key article on crisis resource management were distributed during the first session in order to prepare for the post session two weeks later. Confidence questionnaires were filled out during both sessions. All sessions were videotaped and four blinded independent trained raters assessed the performances. Raters were blinded to the pre/post phase and were not involved in the study. For the application of the massive hemorrhage protocol performances, raters used a checklist derived from the original protocol by experts in the field. For the ability to work in teams, raters used the Mayo High Performance Teamwork Scale. Blood bank technologists were evaluated using a checklist derived by transfusion experts rating necessary steps for preparing and delivering blood products in cases of massive haemorrhages. Scores on performances of the application of the protocol, as well as teamwork performances were recorded. Means and standard deviations of scores for performances were calculated for each scenario. Pre and post training scores were compared using an ANOVA test to assess differences in means. Descriptive statistics of items on the confidence questionnaire were calculated prior to and following training. To assess differences in confidence levels, a Mann Whitney test was used. An alpha of 0.05 was set for all statistics. Results A total of 62 healthcare professionals involved in 8 interdisciplinary teams (4 obstetrics/anaesthesia and 4 paediatric emergency/intensive care) as well as 8 blood bank technologists and 8 haematologists participated in the study. Following training, scores for the application of the protocol improved by 24% (95% CI 10-39). Scores for the ability to work in teams improved by 17% (95% CI 6-28). Confidence levels in the ability to apply the protocol and work in teams improved by 13% (95% CI 11-16). Notable were confidence improvements in leadership and communication skills as well as role and task assignment. Conclusion Targeted training involving HF simulated scenarios and protocol review improved participant ability to apply the massive haemorrhage protocol and to work in interdisciplinary teams. Confidence levels improved among participants from all disciplines. Disclosures None.