Enhancing Postpartum Hemorrhage Response Through Multidisciplinary Training
A multidisciplinary on-site postpartum hemorrhage training exercise with structured team debriefing to evaluate hospital protocols, clinical performance, operational readiness, team communication, and real-time identification of system improvements.
Below is a project walk-through . . .
Approach
A team of subject matter experts from various specialties, including maternal-fetal medicine, obstetrics, anesthesia, neonatology, transfusion services, and nursing, collaborated to create realistic and accurate case-based scenarios and learning objectives. These objectives focused on medical knowledge, patient care, effective communication, and teamwork. The team utilized TeamSTEPPS, a recognized framework for communication and collaboration, which is widely promoted and implemented as best practice in emergency situations within this leading healthcare system.
The training exercise aimed to educate learners in:
- Recognizing and effectively managing obstetric emergencies like postpartum hemorrhage.
- Identifying the need for and activating the massive transfusion protocol while securing blood products.
The scenario incorporated branching storylines, created with wireframing software, that played out on an obstetrical mannequin simulator (Gaumard Scientific, Miami, FL). Before the exercises began, observers received training on debriefing using the advocacy-inquiry method. To ensure a positive learning environment, all participants were informed upfront that the simulations were for quality improvement and skill development.
Implementation
The training exercise unfolded in a real labor and delivery room to replicate a realistic setting. Participants faced a simulated postpartum hemorrhage requiring them to activate our hospital's massive transfusion protocol and obtain blood products (simulated) from the blood bank.
To mimic real-life situations, learners assumed their actual roles within the simulations. Their performance was evaluated by observers from key specialties (obstetrics, anesthesia, nursing, and pediatrics) using standardized forms. These forms categorized actions into medical skills and teamwork/communication effectiveness.
To assess the effectiveness of the obstetric massive transfusion protocol, we incorporated a full blood bank tracer into two simulations. This involved activating the protocol via an overhead announcement to test the system and staff response. Blood bank staff then simulated preparing a complete massive transfusion pack, tracking the time it took with and without a pre-existing type and screen on file for the patient.
Measures
After each simulation, teams participated in a standardized debriefing session. This involved discussions on patient care, medical knowledge, teamwork, communication, and opportunities to improve systems or processes. Participants then received targeted instruction on key medical topics.
To gauge the training's impact, participants anonymously completed voluntary surveys. These surveys assessed the training experience, comfort level managing the case-based scenarios before and after training, and provided space for feedback and suggestions. We measured provider comfort managing obstetric emergencies using a 5-point Likert scale (1 = very uncomfortable, 5 = very comfortable).
Additionally, we monitored the number of postpartum hemorrhage cases before and after the training to identify any improvement trends both 6 months and 1 year after training.
- 96 participants underwent the training, with an impressive 100% response rate on voluntary surveys.
- The majority (70%) were obstetric providers, with a breakdown of obstetric staff/residents (30%), midwives (7%), and labor and delivery nurses (30%).
- The remaining participants (20%) were anesthesia providers.
Results
The program led to a significant increase in key practices across all areas. Registered nurse participation in drills skyrocketed from 0% to 92%. Additionally, healthcare providers significantly improved in:
- Quantifying blood loss (increased from 5% to 45%)
- Performing hemorrhage risk assessments (increased from 10% to 70%)
- Conducting pre-birth and post-birth risk assessments (increased from 2% to 57%)
- Debriefing after drills (increased from 1% to 13%)
These improvements suggest the program's potential to positively impact patient outcomes. Continued efforts are needed to ensure full implementation across all hospital campuses.
The survey results were overwhelmingly positive. Nearly all participants found the exercise valuable, especially in evaluating systems and communication/teamwork. The simulation highlighted areas for improvement in these aspects for many participants. Both participants and observers expressed a strong desire for more frequent training exercises. Notably, the training environment achieved a high level of realism, with many participants reporting feeling stressed during the hemorrhage scenario. Feedback consistently described the case-based training as highly realistic and engaging.
