Training Emergency Department Residents in the Management of Postpartum Hemorrhage: Comparison of Two Approaches [A183

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INTRODUCTION: Postpartum hemorrhage (PPH) is a major contributor to maternal mortality, accounting for 15% of all maternal deaths in the United States. Mortality and morbidity from PPH can be prevented with recognition and rapid intervention. The emergency department (ED) is the first place where women with postpartum hemorrhage present, particularly in areas where obstetric care is limited. Maternity care deserts are defined as counties without a hospital offering obstetric care and no obstetric providers. A total of 34.9% of the counties in the United Sates qualify as maternity care deserts, accounting for 146,451 births. It is critical that ED physicians be trained in the management of PPH. METHODS: The study design is a blinded randomized control trial. Thirty ED residents from Yale New Haven Hospital enrolled completed a pre-intervention survey assessing their baseline knowledge and confidence in managing PPH. Residents received a lecture on the management of PPH. Participants were then randomized into a group that received no further intervention and a group that participated in a simulation and debriefing. One week later, the residents’ clinical skills were evaluated in a simulation and repeated the survey. Clinical skills evaluation and survey test scores of the two groups were compared using t test. Covariates were analyzed by linear regression. RESULTS: All participants improved their knowledge and confidence regardless of the method used. Simulation did not appear to confer additional benefit. CONCLUSION: This study demonstrated that through delivery of a curriculum, we can improve the confidence and the knowledge of ED residents in the management of PPH.