Obstetric emergencies are the most complex situations that can happen in the maternity ward. A multidisciplinary team made up of obstetricians, anesthesiologists, neonatologists, midwives and health assistants normally intervenes in the management of these situations. In this context, it is now known that a majority of complications and morbidity actually result from ineffective teamwork rather than individual failures. The Joint Commission reported in 2004 that most cases of perinatal death and injury were caused by problems with an organization´s culture and communication issues. Non-technical skills such as leadership and teamwork are essential for a successful result in these critical situations. Simulation provides an effective modality to enable interprofessional teams to improve knowledge and attitudes regarding teamwork and to identify effective team skills. Specifically, regarding postpartum hemorrhage, it is recommended simulation exercises to be run “to train staff in the protocols, and to identify and fix system problems that would prevent optimal care”.
In our center, Hospital Clinic of Barcelona, we have established a multidisciplinary simulation program for obstetric emergencies. The detection of some problems related to teamwork during emergencies in the maternity ward led to the development of this program. The program consists on simulation workshops, that take place every two weeks with the following characteristics:
- Simulation scenarios were designed in response to specific needs detected in regular workday by any of the professionals involved. All the simulation cases performed are based in real situations and intend to improve non-technical skills such as communication and teamwork.
- The simulation program is multidisciplinary, integrating all the personnel involved in obstetric emergencies. Besides, clinical scenarios simultaneously include specific elements of each discipline and the immediate debriefing involves each professional as a learner.
- Simulation scenarios are developed “in situ”, in the maternity ward. So as not to interrupt normal activity, one of the delivery rooms and one operating room are blocked for simulation just for one hour to perform the scenario. Prebriefing and posterior debriefing are held in another room outside the maternity ward. “In situ” scenarios provide a high degree of realism and also may reveal latent errors in the environment that potentially could hamper care or harm a patient.
Simulation in situ has several advantages including that the clinical and training spaces are exactly alike and it is quicker and easier to get participants to the simulation location, which is important in multidisciplinary simulation. It also provides the opportunity to do short scenarios between clinical responsibilities. However, it is important to do not disturb patients or other staff and to assure psychological safety for the participants, especially in a multidisciplinary scenario in one´s daily work site.
Written by the Barcelona Team from Hospital Clinic Barcelona