Clinical Effectiveness of Simulation in Eclampsia and Obstetrical Hypertensive Emergencies [24S

Abstract

INTRODUCTION: Simulation prepares teams for rapid response to rare obstetrical emergencies like hypertensive crisis and eclampsia. The study objective was to determine the clinical effectiveness of teamwork simulation training in eclampsia and obstetrical hypertensive emergencies. METHODS: A prospective quasi-experimental educational study design was used to assess the effectiveness of a simulation curriculum on eclampsia and hypertensive emergency. A high fidelity manikin was programmed to produce seizures and hypertension. Outcomes were measured using pre/post knowledge tests, performance assessment scores, safety culture surveys and clinical parameters of intensive care unit (ICU) admissions and length of stay. Internal review board exemption was obtained. Paired t-tests and repeated measures were used for data analysis. RESULTS: Over one year, 256 obstetrical staff participated in weekly drills in a large obstetrical hospital with over 10,000 deliveries per year. Statistically significant improvement occurred in pre-post scores of knowledge (59.86%, 93.87%, p<0.0001), performance (56.54%, 93.54%, p<0.0001) and safety culture (3.12, 1.45, 1=high 5=low, p<0.0001). Clinical outcomes for patients diagnosed with eclampsia indicated fewer ICU admissions and shorter lengths of stay (pre 4.58 days, post 3.50 days, p=0.048) as compared with the year prior to initiation of the simulation program. CONCLUSION: Teamwork simulation training demonstrated improved team knowledge, performance and attitudes for responsiveness to hypertensive emergencies and eclampsia. Fewer ICU admissions and shorter lengths of stay for these rare events suggest improved patient care after initiating teamwork training.