Explicit Communication in an Obstetrical Emergency

Abstract

Introduction: One of the hallmarks of a high-performance team is the use of a common language during emergency situations. In domains where formed teams are the typical organizational structure, clear conversation using common terms is especially important to avoid misunderstandings and to reduce the communication burden. We believe that labor and delivery teams might benefit from standardizing vocabulary during obstetrical emergencies. To understand the current vocabulary used we observed the declaration of a relatively common obstetrical emergency, shoulder dystocia, during a simulation exercise. Methods: Obstetricians, labor nurses, and anesthesiologists participate in a simulation-based teamwork course at the Center for Medical Simulation on a weekly basis. All participants are post-graduate practitioners with a wide range of experience (6mo to >30yrs) from one of 14 different institutions. One of the case scenarios presented is an unanticipated shoulder dystocia using an apparatus we have described previously1. Investigators reviewed a sample of 12 videotapes randomized within institutions from a pool of 46 to document the vocabulary used in declaring the emergency. The obstetrical maneuvers that were used initially to relieve the shoulder dystocia were also recorded. Results: The most common terminology used was: “shoulder dystocia” (33%), “we have a shoulder” (33%), “get a stool” (20%), and “it’s stuck” (13%). All participants used the McRoberts maneuver and/or suprapubic pressure as their first maneuvers to manage the shoulder dystocia. There were no apparent misunderstandings between the team members that were observed. Discussion: Although we saw no obvious sequela, we noted a variety of terms used to declare this critical event. During debriefings the most common reason cited by the obstetrician for not using the term “shoulder dystocia” was a desire not to alarm the patient and family. We remain concerned that the lack of a common terminology could result in misunderstanding and a delay in treatment during this critical event. We hope to develop a universal practice of declaring a shoulder dystocia by its technical name throughout our obstetrical practices. 1 Walzer TB, Gardner R, Raemer DB. Obstetrical Emergency - an Apparatus to Simulate Shoulder Dystocia. Anesth Analg, 2004; 98 S39 Conflict of Interest: Authors indicated they have nothing to disclose.