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Kaijomaa M, Gissler M, Äyräs O, Sten A, Grahn P. Impact of simulation training on the management of shoulder dystocia and incidence of permanent brachial plexus birth injury: an observational study. BJOG 2022; 130:70-77. [PMID: 36052568 PMCID: PMC10087175 DOI: 10.1111/1471-0528.17278] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/05/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the impact of shoulder dystocia (SD) simulation training on the management of SD and the incidence of permanent brachial plexus birth injury (BPBI). DESIGN Retrospective observational study. SETTING Helsinki University Women's Hospital, Finland. SAMPLE Deliveries with SD. METHODS Multi-professional, regular and systematic simulation training for obstetric emergencies began in 2015, and SD was one of the main themes. A study was conducted to assess changes in SD management and the incidence of permanent BPBI. The study period was from 2010 to 2019; years 2010-2014 were considered the pre-training period and years 2015-2019 were considered the post-training period. MAIN OUTCOME MEASURES The primary outcome measure was the incidence of permanent BPBI after the implementation of systematic simulation training. Changes in the management of SD were also analysed. RESULTS During the study period, 113 085 vertex deliveries were recorded. The incidence of major SD risk factors (gestational diabetes, induction of labour, vacuum extraction) increased and was significantly higher for each of these factors during the post-training period (p < 0.001). The incidence of SD also increased significantly (0.01% vs 0.3%, p < 0.001) during the study period, but the number of children with permanent BPBI decreased by 55% after the implementation of systematic simulation training (0.05% vs 0.02%, p < 0.001). The most significant change in the management of SD was the increased incidence of successful delivery of the posterior arm. CONCLUSIONS Systematic simulation-based training of midwives and doctors can translate into improved individual and team performance and can significantly reduce the incidence of permanent BPBI.
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Affiliation(s)
- M. Kaijomaa
- Department of Obstetrics and Gynaecology University of Helsinki and Helsinki University Hospital Finland
| | - M. Gissler
- Finnish Institute for Health and Welfare Helsinki, Finland; Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden; Karolinska Institutet, Department of Molecular Medicine and Surgery Stockholm Sweden
| | - O. Äyräs
- Department of Obstetrics and Gynaecology University of Helsinki and Helsinki University Hospital Finland
| | - A. Sten
- Department of Obstetrics and Gynaecology University of Helsinki and Helsinki University Hospital Finland
| | - P. Grahn
- Department of Orthopaedics and Traumatology, New Children’s Hospital University of Helsinki and Helsinki University Hospital Finland
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Heffernan R, Brumpton K, Randles D, Pinidiyapathirage J. Acceptability, technological feasibility and educational value of remotely facilitated simulation based training: A scoping review. MEDICAL EDUCATION ONLINE 2021; 26:1972506. [PMID: 34433385 PMCID: PMC8405121 DOI: 10.1080/10872981.2021.1972506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/11/2021] [Accepted: 08/20/2021] [Indexed: 05/25/2023]
Abstract
Although remote teaching and learning is not new to medical education, the Covid-19 pandemic has heightened its importance as a mode of education delivery. This scoping review aims to provide a narrative/iterative summary of the current literature in assessing the acceptability, educational value and technological feasibility of remotely facilitated (RF) simulation-based training (SBT) - 'telesimulation', for medical students and facilitators. The review was conducted using the method described by Arksey and O'Malley. A systematic process was followed to search multiple electronic databases supplemented with a general internet search to identify any relevant grey literature. The search strategy was developed in collaboration with medical students and educators familiar with SBT. Nine articles were identified as fitting the review inclusion criteria. The results indicated that RF SBT was positively viewed by participants but may not be viewed as equivalent to locally facilitated SBT. Participants of RF SBT felt confident to deal with common acute scenarios, believed it could expand their knowledge and skills and in turn would improve patient care in the clinical setting. Facilitators found RF SBT to be technologically feasible, promoting the acquisition of desired learning outcomes. Future research should assess the reaction to, and learning acquired during RF SBT, particularly, the perception and attitudes of facilitators. A clear research gap was identified in literature assessing the role of RF SBT in behavioural change and improved clinical care outcomes. Addresing these gaps will clarify the role of RF SBT in medical education.
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Affiliation(s)
- Robert Heffernan
- Rural Medical Education Australia, Toowoomba, QLDAustralia
- Griffith University, School of Medicine and Dentistry, Gold Coast, QLD, Australia
| | - Kay Brumpton
- Rural Medical Education Australia, Toowoomba, QLDAustralia
- Griffith University, School of Medicine and Dentistry, Gold Coast, QLD, Australia
| | - David Randles
- Griffith University, School of Medicine and Dentistry, Gold Coast, QLD, Australia
| | - Janani Pinidiyapathirage
- Rural Medical Education Australia, Toowoomba, QLDAustralia
- Griffith University, School of Medicine and Dentistry, Gold Coast, QLD, Australia
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Fritz J, Montoya A, Lamadrid-Figueroa H, Flores-Pimentel D, Walker D, Treviño-Siller S, González-Hernández D, Magaña-Valladares L. Training in obstetric and neonatal emergencies in Mexico: effect on knowledge and self-efficacy by gender, age, shift, and profession. BMC MEDICAL EDUCATION 2020; 20:97. [PMID: 32234024 PMCID: PMC7110675 DOI: 10.1186/s12909-020-02005-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 03/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Continuing education is essential for healthcare workers. Education interventions can help to maintain and improve competency and confidence in the technical skills necessary to address adverse events. However, characteristics of the health provider such as age (related to more critical and reflexive attitude); sex (relationship with gender socialization), profession and work conditions might have an influence on the effect of continuing education efforts. METHODS A training in the management of obstetric and neonatal emergencies (PRONTO, Spanish acronym for Neonatal and Obstetric Rescue Program: Optimal and Timely treatment) was implemented in 14 hospitals in six Mexican states between 2013 and 2014, with a before-after evaluation design. A total of 351 health providers including physicians, interns, nurses and midwives completed the training and were included in the analytic sample. Mixed-effects regression models were fitted to model changes in knowledge and self-efficacy scores after the training for each training topic. Interaction terms of training with age, gender, profession, and shift were included to evaluate possible heterogeneities of effect. All models considered the within-hospital clustering of participants. RESULTS After training, all participants showed a significant knowledge gain by an average of 19 percentage points for hemorrhage, 23 for neonatal resuscitation, 19 for shoulder dystocia, and 15 for preeclampsia/eclampsia (p < 0.001). Participants who worked night shifts showed lower scores for overall knowledge, compared with morning shift workers. Interns perceived the lowest self-efficacy while they scored very high in knowledge. Self-efficacy in managing obstetric and neonatal emergencies increased significantly by 16 percentage points in average. CONCLUSIONS Our results show that PRONTO is generally successful in increasing knowledge and self-efficacy on all topics but knowledge and self efficacy levels vary greatly by factors such as work shift. Training should be particularly aimed at personnel working during weekends and night shifts, as well as interns and nurses.
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Affiliation(s)
- Jimena Fritz
- Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Universidad No. 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, CP Mexico
| | - Alejandra Montoya
- Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Universidad No. 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, CP Mexico
| | - Héctor Lamadrid-Figueroa
- Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Universidad No. 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, CP Mexico
| | - Delia Flores-Pimentel
- Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Universidad No. 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, CP Mexico
| | - Dilys Walker
- Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA 94110 USA
| | - Sandra Treviño-Siller
- Dirección de Retos y Determinantes del Sistema de Salud, Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Universidad No. 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, CP Mexico
| | - Dolores González-Hernández
- Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Universidad No. 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, CP Mexico
| | - Laura Magaña-Valladares
- Association of Schools and Programs of Public Health (ASPPH), 1900 M St NW Suite 710, Washington, DC 20036 USA
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Hopwood N, Blomberg M, Dahlberg J, Abrandt Dahlgren M. Three Principles Informing Simulation-Based Continuing Education to Promote Effective Interprofessional Collaboration: Reorganizing, Reframing, and Recontextualizing. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:81-88. [PMID: 32404776 DOI: 10.1097/ceh.0000000000000292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Shoulder dystocia is a complex birth emergency where patient outcomes remain a concern. This article investigates the detailed processes of simulation-based continuing education in a hospital where evidence over 10 years demonstrates improvements in practitioner knowledge, enacted practices, and maternal and child outcomes. METHODS Data were collected by video recording teams participating in a shoulder dystocia simulation and debrief. Analysis combined grounded thematic development with purposive coding of enactments of a relevant protocol (the ALSO HELPERR). RESULTS Three themes were identified (three Rs) that capture how effective interprofessional collaboration is promoted through collectively oriented reflection: Reorganizing roles and responsibilities between team members; Reframing the problem of shoulder dystocia from individuals correctly following a protocol, to a team of professionals who need to attune to, respond to, and support one another; and Recontextualizing by collectively "commingling" theoretical knowledge with practical experience to reflect on actions and judgements. DISCUSSION The three Rs are relevant to diverse clinical settings and address gaps in knowledge relating to the process of interprofessional simulation. Together, they constitute a set of principles to inform the design and conduct of continuing education for interprofessional practice through simulation.
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Affiliation(s)
- Nick Hopwood
- Dr. Hopwood: Associate Professor, School of International Studies and Education, University of Technology Sydney, Sydney, Australia, and Department of Curriculum Studies, Stellenbosch Universiteit, Stellenbosch, South Africa. Ms. Blomberg: Professor, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden, and Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden. Ms. Dahlberg: Senior Lecturer, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. Ms. Abrandt Dahlgren: Professor in Medical Education, Department of Medicine and Health, Linköping University, Linköping, Sweden
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McArdle J, Sorensen A, Fowler CI, Sommerness S, Burson K, Kahwati L. Strategies to Improve Management of Shoulder Dystocia Under the AHRQ Safety Program for Perinatal Care. J Obstet Gynecol Neonatal Nurs 2018; 47:191-201. [PMID: 29304317 DOI: 10.1016/j.jogn.2017.11.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess implementation of safety strategies to improve management of births complicated by shoulder dystocia in labor and delivery units. DESIGN Mixed-methods implementation evaluation. SETTING/LOCAL PROBLEM Labor and delivery units (N = 18) in 10 states participating in the Safety Program for Perinatal Care (SPPC). Shoulder dystocia is unpredictable, requiring rapid and coordinated action. PARTICIPANTS Key informants were labor and delivery unit staff who implemented SPPC safety strategies. INTERVENTION/MEASUREMENTS The SPPC was implemented by using the TeamSTEPPS teamwork and communication framework and tools, applying safety science principles (standardization, independent checks, and learn from defects) to shoulder dystocia management, and establishing an in situ simulation program focused on shoulder dystocia to practice teamwork and communication skills. Unit staff received training, a toolkit, technical assistance, and unit-specific feedback reports. Quantitative data on unit-reported process improvement measures and qualitative data from staff interviews were used to understand changes in use of safety principles, teamwork/communication, and in situ simulation. RESULTS Use of shoulder dystocia safety strategies improved on the units. Differences between baseline and follow-up (10 months) were as follows: in situ simulation (50% vs. 89%), teamwork and communication (67% vs. 94%), standardization (67% to 94%), learning from defects (67% vs. 89%), and independent checks (56% vs. 78%). Interview data showed reasons to address management of shoulder dystocia, various approaches to implement safety practices, and facilitators and barriers to implementation. CONCLUSION Successful management of shoulder dystocia requires a rapid, standardized, and coordinated response. The SPPC strategies to increase safety of shoulder dystocia management are scalable, replicable, and adaptable to unit needs and circumstances.
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Hart D, Nelson J, Moore J, Gross E, Oni A, Miner J. Shoulder Dystocia Delivery by Emergency Medicine Residents: A High-fidelity versus a Novel Low-fidelity Simulation Model-A Pilot Study. AEM EDUCATION AND TRAINING 2017; 1:357-362. [PMID: 30051055 PMCID: PMC6001827 DOI: 10.1002/aet2.10054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 07/19/2017] [Accepted: 08/01/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Shoulder dystocia (SD) requires emergent intervention to prevent maternal and fetal harm, and simulation models for training can be expensive. We developed a novel, cheap and easily transportable low-fidelity simulation (LFS) model to compare to a commercially available high-fidelity simulation (HFS) model. METHODS Emergency medicine residents were randomized to training on the HFS or novel LFS model. Subjects completed a pretest and a 1-week and 6-month posttest including a self-assessment and a simulated SD delivery. RESULTS Twenty-seven of the 43 residents completed the study (63%). The number of individuals performing dangerous maneuvers at baseline was similar, 1 week after training was five in HFS and 11 in LFS (p = 0.08) groups and at 6 months was again similar between groups. Mean checklist scores for appropriate actions increased 1 week after training but returned to baseline by 6 months and were similar between groups. The rate of successful delivery, median time to successful delivery, and maximum force applied improved at 1 week and was sustained at 6 months in both groups. CONCLUSION Within our limited study population, we did not find a large difference in the occurrence of dangerous actions during simulated SD delivery following HFS and LFS training. Our novel and easily transportable LFS trainer, assembled for less than US$10 each, may be a useful tool to train inexperienced providers on the steps of this procedure. However, this requires further study, as does whether HFS models with force monitoring capabilities may be helpful to train providers to minimize dangerous maneuvers such as the application of excessive force.
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Affiliation(s)
- Danielle Hart
- Department of Emergency MedicineHennepin County Medical Center
- University of Minnesota Medical School
| | - Jessie Nelson
- University of Minnesota Medical School
- Department of Emergency Medicine at Regions Hospital
| | - Johanna Moore
- Department of Emergency MedicineHennepin County Medical Center
- University of Minnesota Medical School
| | - Eric Gross
- Department of Emergency MedicineHennepin County Medical Center
- Present address:
Department of Emergency MedicineUniversity of California at Davis
| | - Adeleki Oni
- University of Minnesota Medical School
- Present address:
Department of Emergency MedicineUniversity of Maryland Medical Center
| | - James Miner
- Department of Emergency MedicineHennepin County Medical Center
- University of Minnesota Medical School
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Team Training and Institutional Protocols to Prevent Shoulder Dystocia Complications. Clin Obstet Gynecol 2016; 59:830-840. [DOI: 10.1097/grf.0000000000000231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Interdisciplinary collaboration to maintain a culture of safety in a labor and delivery setting. J Perinat Neonatal Nurs 2013; 27:113-23; quiz 124-5. [PMID: 23618932 DOI: 10.1097/jpn.0b013e31828cbb2a] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A culture of safety is a growing movement in obstetrical healthcare quality and management. Patient-centered and safe care is a primary priority for all healthcare workers, with communication and teamwork central to achieving optimal maternal health outcomes. A mandatory educational program was developed and implemented by physicians and nurses to sustain awareness and compliance to current protocols within a large university-based hospital. A didactic portion reviewing shoulder dystocia, operative vaginal delivery, obstetric hemorrhage, and fetal monitoring escalation was combined with a simulation session. The simulation was a fetal bradycardia activating the decision to perform an operative vaginal delivery complicated by a shoulder dystocia. More than 370 members of the healthcare team participated including obstetricians, midwives, the anesthesia team, and nurses. Success of the program was measured by an evaluation tool and comparing results from a prior safety questionnaire. Ninety-seven percent rated the program as excellent, and the response to a question on perception of overall grade on patient safety measured by the Agency for Healthcare Research and Quality safety survey demonstrated a significant improvement in the score (P = .003) following the program.
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Using simulation to teach nursing students and licensed clinicians obstetric emergencies. MCN Am J Matern Child Nurs 2013; 37:394-400. [PMID: 23073253 DOI: 10.1097/nmc.0b013e318264bbe7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Improving patient safety in healthcare has reached critical mass both in the United States and worldwide. Effective communication between nurses and other members of the healthcare team is an essential component of patient safety. In obstetrics, poor communication and teamwork were causative factors in many of reviewed sentinel event cases. Simulation is a recommended teaching strategy used to improve communication and teamwork skills, and therefore patient safety, among interprofessional team members. This article offers a strategy in the form of a shoulder dystocia simulation that can be implemented in either academic or clinical settings. Simulations such as this one can be used to enhance teamwork and communication skills of healthcare professionals, both in educational institutions and in clinical practice settings, with a goal of improving patient safety.
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Blanchard MH, Kriebs JM. A Successful Model of Collaborative Practice in a University-Based Maternity Care Setting. Obstet Gynecol Clin North Am 2012; 39:367-72. [DOI: 10.1016/j.ogc.2012.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Chakravarthy B, Ter Haar E, Bhat SS, McCoy CE, Denmark TK, Lotfipour S. Simulation in medical school education: review for emergency medicine. West J Emerg Med 2012; 12:461-6. [PMID: 22224138 PMCID: PMC3236168 DOI: 10.5811/westjem.2010.10.1909] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 08/03/2010] [Accepted: 10/18/2010] [Indexed: 01/22/2023] Open
Abstract
Medical education is rapidly evolving. With the paradigm shift to small-group didactic sessions and focus on clinically oriented case-based scenarios, simulation training has provided educators a novel way to deliver medical education in the 21st century. The field continues to expand in scope and practice and is being incorporated into medical school clerkship education, and specifically in emergency medicine (EM). The use of medical simulation in graduate medical education is well documented. Our aim in this article is to perform a retrospective review of the current literature, studying simulation use in EM medical student clerkships. Studies have demonstrated the effectiveness of simulation in teaching basic science, clinical knowledge, procedural skills, teamwork, and communication skills. As simulation becomes increasingly prevalent in medical school curricula, more studies are needed to assess whether simulation training improves patient-related outcomes.
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Affiliation(s)
- Bharath Chakravarthy
- University of California, Irvine, Department of Emergency Medicine, Orange, California
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Hansen SS, Arafeh J. Implementing and Sustaining In Situ Drills to Improve Multidisciplinary Health Care Training. J Obstet Gynecol Neonatal Nurs 2012; 41:559-70; quiz 570-1. [DOI: 10.1111/j.1552-6909.2012.01376.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
Traditionally, continuing education has focused on cognitive skills and technical skills, namely, what the provider needs to know and what the provider needs to be able to do. Successful completion of such education programs has conferred some degree of competence on the learner. For the most part, continuing education has been performed in silos with each healthcare provider discipline developing a program designed to meet the needs of their group. The Institute of Medicine and the Joint Commission have issued reports addressing patient safety, morbidity, and mortality of the newborn infant and maternal mortality, respectively. These reports call for the education of healthcare providers to include multidisciplinary team training and/or drills. Simulation-based training (SBT) is a methodology of education that is uniquely able to address cognitive and technical skills as well as behavioral skills and is ideal for multidisciplinary team training. As a result, SBT is beginning to be adopted in healthcare education. However, the following questions remain: Is a dedicated simulation space necessary, how should SBT be incorporated into the existing education program, and will it confer competency?
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Ennen CS, Satin AJ. Training and assessment in obstetrics: the role of simulation. Best Pract Res Clin Obstet Gynaecol 2010; 24:747-58. [DOI: 10.1016/j.bpobgyn.2010.03.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 03/22/2010] [Indexed: 12/20/2022]
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Gittens-Williams L. Contemporary Management of Shoulder Dystocia. WOMENS HEALTH 2010; 6:861-9. [DOI: 10.2217/whe.10.65] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Shoulder dystocia is an uncommon but potentially catastrophic intrapartum event. Although risk factors such as maternal diabetes, obesity and macrosomia can be identified, shoulder dystocia most frequently occurs in patients who lack risk factors. Many maneuvers have been described to assist the operator in the safe release of the shoulder and subsequent delivery; however, no prospective trials have compared these maneuvers in such a way to suggest that one maneuver is superior to another. This article describes the identification of patients at risk for shoulder dystocia, clinical management of the shoulder dystocia, event documentation and the contemporary use of drills and simulation training to improve team preparedness for this unpredictable and usually unavoidable event.
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Affiliation(s)
- Lisa Gittens-Williams
- Department of Obstetrics, Gynecology and Women's Health, New Jersey Medical School, 185 South Orange Avenue MSB E 506 Newark, NJ 07103, USA, Tel.: +1 973 972 5344, Fax: +1 973 972 4574,
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Daniel LT, Simpson EK. Integrating team training strategies into obstetrical emergency simulation training. J Healthc Qual 2010; 31:38-42. [PMID: 19813559 DOI: 10.1111/j.1945-1474.2009.00045.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Successful management of obstetrical emergencies such as shoulder dystocia requires the coordinated efforts of a multidisciplinary team of professionals. Simulation education provides an opportunity to learn and master simple as well as complex technical skills needed in emergent situations. Team training has been shown to improve the quality of communication among team members and consequently has an enormous impact on human performance. In the healthcare environment, especially obstetrics where the stakes are high, integrating team training into simulation education can advance efforts to create and sustain a culture of safety. With over 7,100 deliveries annually, our 1,100-bed, two-hospital regional healthcare system embarked on this journey to advance the culture of safety.
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Obstetric care in low-resource settings: what, who, and how to overcome challenges to scale up? Int J Gynaecol Obstet 2010; 107 Suppl 1:S21-44, S44-5. [PMID: 19815204 DOI: 10.1016/j.ijgo.2009.07.017] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Each year, approximately 2 million babies die because of complications of childbirth, primarily in settings where effective care at birth, particularly prompt cesarean delivery, is unavailable. OBJECTIVE We reviewed the content, impact, risk-benefit, and feasibility of interventions for obstetric complications with high population attributable risk of intrapartum-related hypoxic injury, as well as human resource, skill development, and technological innovations to improve obstetric care quality and availability. RESULTS Despite ecological associations of obstetric care with improved perinatal outcomes, there is limited evidence that intrapartum interventions reduce intrapartum-related neonatal mortality or morbidity. No interventions had high-quality evidence of impact on intrapartum-related outcomes in low-resource settings. While data from high-resource settings support planned cesarean for breech presentation and post-term induction, these interventions may be unavailable or less safe in low-resource settings and require risk-benefit assessment. Promising interventions include use of the partograph, symphysiotomy, amnioinfusion, therapeutic maneuvers for shoulder dystocia, improved management of intra-amniotic infections, and continuous labor support. Obstetric drills, checklists, and innovative low-cost devices could improve care quality. Task-shifting to alternative cadres may increase coverage of care. CONCLUSIONS While intrapartum care aims to avert intrapartum-related hypoxic injury, rigorous evidence is lacking, especially in the settings where most deaths occur. Effective care at birth could save hundreds of thousands of lives a year, with investment in health infrastructure, personnel, and research--both for innovation and to improve implementation.
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Fuchs KM, Miller RS, Berkowitz RL. Optimizing outcomes through protocols, multidisciplinary drills, and simulation. Semin Perinatol 2009; 33:104-8. [PMID: 19324239 DOI: 10.1053/j.semperi.2008.12.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Delay in diagnosis, failure to employ sufficient medical and surgical treatments, and poor teamwork all may contribute to suboptimal outcomes in cases of postpartum hemorrhage. A significant portion of hemorrhage-related maternal morbidity may be prevented through early diagnosis and rapid intervention. There is a small but growing body of literature describing the role of patient safety initiatives and simulation training in optimizing outcomes following postpartum hemorrhage. Rapid response teams may be used to facilitate coordination between various personnel involved in the management of postpartum hemorrhage. Hemorrhage drills and simulation-based training may help providers achieve timely and coordinated responses in the treatment of postpartum hemorrhage. Protocol may help to standardize management in cases of postpartum hemorrhage, thereby minimizing unnecessary errors or delays in care. Additional research is warranted to further determine the impact of patient safety initiatives and simulation training on outcomes in the setting of obstetric hemorrhage.
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Affiliation(s)
- Karin M Fuchs
- Division of Maternal Fetal Medicine, Columbia Presbyterian Medical Center, New York, NY 10032, USA.
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Building Team and Technical Competency for Obstetric Emergencies: The Mobile Obstetric Emergencies Simulator (MOES) System. Simul Healthc 2009; 4:166-73. [DOI: 10.1097/sih.0b013e31819aaf2a] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Best practices in perinatal nursing: risk identification and management of shoulder dystocia. J Perinat Neonatal Nurs 2008; 22:91-4. [PMID: 18496066 DOI: 10.1097/01.jpn.0000319093.52049.bc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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