title: Simulation Study Assessing Healthcare Provider's Knowledge of Pre-Eclampsia and Eclampsia in a Tertiary Referral Center.
abstract: BACKGROUND
  The aim of the study was to assess knowledge of labor and delivery healthcare providers at a tertiary referral center in the management of pre-eclampsia and eclampsia.
  
  
  METHODS
  Thirteen multidisciplinary teams participated in this institutional review board-exempt study. Each group encountered the same scenario that involved a pre-eclamptic parturient who progressed to eclampsia. The participants were unaware of the scenario topic before the drill and that key interventions would be recorded and timed. Seven of 13 groups were randomized to have a cognitive aid available.
  
  
  RESULTS
  Twelve of 13 groups attempted to lower the blood pressure; however, only 7 of 12 groups used the correct first-line antihypertensive medication as per the American College of Obstetricians and Gynecologists' guidelines. All groups requested and administered the correct bolus dose of magnesium (4-6 g intravenously). Only 2 of 13 groups took appropriate action to lower the blood pressure to a "safe range" before induction of general anesthesia, and 4 of the 13 anesthesiologists made drug modifications for induction of anesthesia. None of the 7 groups randomized to have a cognitive aid used it.
  
  
  CONCLUSIONS
  Our results show widespread magnesium sulfate utilization; however, the use of antihypertensive medication is not universally administered in compliance with current guidelines. The importance of blood pressure management to reduce maternal morbidity and mortality in the setting of pre-eclampsia needs to be emphasized. Interestingly, availability of a cognitive aid did not ensure its utilization in this scenario. Findings suggest that for cognitive aids to be effectively used, it is essential that staff has been trained and become familiar with them before an emergent event.
authors.affiliation: From the Department of Anesthesiology, Perioperative and Pain Medicine (G.H., B.C.) and Department of Obstetrics and Gynecology (K.D.), Stanford University School of Medicine, Stanford, CA.
authors.forename: Gillian
authors.initials: G
authors.lastname: Hilton
authors.forename: Kay
authors.initials: K
authors.lastname: Daniels
authors.forename: Brendan
authors.initials: B
authors.lastname: Carvalho
mesh_terms: D000328:Adult; D004461:Eclampsia / Q000628:therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007318:Inservice Training; D008505:Medical Staff, Hospital / Q000193:education*; D009741:Nursing Staff, Hospital / Q000193:education*; D010348:Patient Care Team; D011225:Pre-Eclampsia / Q000628:therapy*; D011247:Pregnancy; D062606:Tertiary Care Centers