title: Opportunities to Foster Efficient Communication in Labor and Delivery Using Simulation.
abstract: IntroductionCommunication errors are an important contributing factor in adverse outcomes in labor and delivery (L&D) units. The objective of this study was to identify common lapses in verbal communication using simulated obstetrical scenarios and propose alternative formats for communication.MethodsHealth care professionals in L&D participated in three simulated clinical scenarios. Scenarios were recorded and reviewed to identify questions repeated within and across scenarios. Questions that were repeated more than once due to ineffective communication were identified. The frequency with which the questions were asked across simulations was identified.ResultsQuestions were commonly repeated both within and across 27 simulated scenarios. The median number of questions asked was 27 per simulated scenario. Commonly repeated questions focused on three general topics: (1) historical data/information (i.e., estimated gestational age), (2) maternal clinical status (i.e., estimated blood loss), and (3) personnel (i.e., "Has anesthesiologist been called?").ConclusionInefficient verbal communication exists in the process of transferring information during obstetric emergencies. These findings can inform improved training and development of information displays to improve teamwork and communication. A visual display that can report static historical information and specific dynamic clinical data may facilitate optimal human performance.
authors.affiliation: Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California; Department of Pediatrics, Safety Learning Laboratory for Neonatal and Maternal Care, Stanford University, Stanford, California.
authors.forename: Kay
authors.initials: K
authors.lastname: Daniels
authors.affiliation: Department of Pediatrics, Safety Learning Laboratory for Neonatal and Maternal Care, Stanford University, Stanford, California.
authors.forename: Colleen
authors.initials: C
authors.lastname: Hamilton
authors.affiliation: Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California; Department of Pediatrics, Safety Learning Laboratory for Neonatal and Maternal Care, Stanford University, Stanford, California.
authors.forename: Susan
authors.initials: S
authors.lastname: Crowe
authors.affiliation: Department of Pediatrics, Safety Learning Laboratory for Neonatal and Maternal Care, Stanford University, Stanford, California; Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Steven S
authors.initials: SS
authors.lastname: Lipman
authors.affiliation: Department of Pediatrics, Safety Learning Laboratory for Neonatal and Maternal Care, Stanford University, Stanford, California; Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
authors.forename: Louis P
authors.initials: LP
authors.lastname: Halamek
authors.affiliation: Department of Pediatrics, Safety Learning Laboratory for Neonatal and Maternal Care, Stanford University, Stanford, California; Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
authors.forename: Henry C
authors.initials: HC
authors.lastname: Lee
keywords: communication; health care professionals; labor and delivery; simulation