Impact of simulation and team training on postpartum hemorrhage management in non-academic centers.
OBJECTIVE
Prompt recognition and response to postpartum hemorrhage (PPH) are vital in preventing maternal morbidity and mortality. We conducted a multi-center study to evaluate in situ simulation and team training for PPH among experienced clinical teams in non-academic hospitals in urban and rural communities.


METHODS
A longitudinal intervention study was performed in six Oregon community hospitals. All teams responded to an in situ simulated delivery and postpartum hemorrhage using trained actors and an obstetric birthing simulator, followed by a debriefing and training session. The simulation scenario was then repeated in 9-12 months. All sessions were digitally video recorded and independently reviewed by two obstetricians using a structured evaluation form. PPH management including clinical response times were compared before and after team training using Student's paired t-test and McNemar's test.


RESULTS
Twenty-two teams completed paired case simulations. Team training significantly improved response times in the management of PPH, including the recognition of PPH, time to administer first medication, performance of uterine massage and time to administer second medication. Medical management (use of three indicated medications) improved after training from 27.3% to 63.6%, p = 0.01.


CONCLUSIONS
Simulation and team training significantly improved postpartum hemorrhage response times among clinically experienced community labor and delivery teams.
Department of Obstetrics and Gynecology .
Nicole E
NE
Marshall
Jeroen
J
Vanderhoeven
Karen B
KB
Eden
Sally Y
SY
Segel
Jeanne-Marie
JM
Guise
D000328:Adult; D002983:Clinical Competence; D036861:Delivery, Obstetric / Q000193:education*; D004501:Education, Medical / Q000379:methods; D005260:Female; D006761:Hospitals; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000592:standards; D016544:Patient Simulation; D010820:Physicians / Q000592:standards; D006473:Postpartum Hemorrhage / Q000517:prevention & control / Q000628:therapy*; D011247:Pregnancy
Clinical competence; education; outcome and process assessment; patient care team; postpartum hemorrhage; pregnancy complications; simulation