Can Interprofessional Simulation Training Influence the Frequency of Blood Transfusions After Birth?

Abstract

Objective. To investigate whether inter-professional simulation training influenced the rate of red blood cell (RBC) transfusions after birth. Design. Two cohorts were compared retrospectively using a pre-post design. Setting. Norwegian university hospital with 4800 deliveries annually. Population. Women with estimated blood loss >500 mL within 24 h after birth in 2009 and 2011. Methods. In 2010, all maternity staff attended a 6-h, scenario-based training on emergency obstetrics including postpartum hemorrhage, using a birthing simulator. The simulation focused on prevention, identification, and treatment of postpartum hemorrhage and on communication and leadership. Debrief immediately after the scenarios involved reflection and self-assessment. Main outcome measures. The frequency of women receiving RBC transfusions as a marker for blood loss. Secondary outcome was the frequency of surgical procedures in the management of postpartum hemorrhage. Results. In 2009, 111/534 (20.8%) women with estimated blood loss >500 mL after birth received RBC transfusions vs. 67/546 (12.3%) in 2011 (p < 0.01). The adjusted odds ratio for women receiving RBC transfusions in 2011 vs. 2009 was 0.53 (95% CI 0.38-0.74). Parity, oxytocin augmentation, duration of second stage, episiotomy, operative vaginal delivery, and sphincter injury were included in the final model. The odds ratio was stable in all combinations of possible confounders. We observed a significant reduction in the frequencies of curettage (p < 0.01) and uterine artery embolizations (p = 0.01). Conclusion. We found a significant reduction in RBC transfusions after birth, which might be associated with mandatory simulation training. A causal link cannot be documented because of complex interactions of several variables.Abbreviations: CS, cesarean section; Hgb, hemoglobin; PPH, postpartum hemorrhage; RBC, red blood cell. Key MessageWe examined whether inter-professional simulation training could influence the rate of red blood cell transfusions after birth and observed a significant reduction in red blood cell transfusions, curettages, and uterine artery embolization after introduction of mandatory simulation training on management of postpartum hemorrhage.

Effects of an in situ instructional design based postpartum hemorrhage simulation training on patient outcomes: an uncontrolled before-and-after study

“…The multiple ID features adopted (such as authentic multiple scenarios and easy-to-complex progression) and the in situ simulation using both a part-task simulator and simulated patient promoted the complex learning required for PPH management by postgraduates [14,15,22]. Second, investigation of patient outcomes (Kirkpatrick's level 4) has long been recognized as essential however complex and subject to system issues [9,11,18].…”

“…Proper PPH management requires early recognition and prompt bleeding control (i.e. adequate situational awareness) and minimizes complications such as blood transfusions, hysterectomy, near-miss maternal mortality, or maternal death [2,3,18]. It requires coordination of constitutively different skills (e.g.…”

“…These characteristics reinforce PPH value as subject for simulation. Of the wide variety of reported PPH outcomes, those presented most common are uterotonics administration and/or blood transfusion rates [11,18].…”