Evaluation of multidisciplinary shoulder dystocia simulation training on knowledge, performance, and documentation

Abstract

BACKGROUND: Research has shown the utility of simulations involving individuals, yet little data exist on whether communication and documentation are impacted by the integration of all team members into a scenario. In 2018, the obstetrics department at this tertiary hospital began a multidisciplinary team-training simulation for shoulder dystocia. An educational portion was included, teaching a new practice where the provider announces delivery events (head, shoulder, body) to be marked on the delivery record, a standardized approach was introduced, and a pre-and post-simulation test was administered. OBJECTIVE: In this study, we sought to evaluate the lasting impact of this team-based tool on the outcomes and documentation of shoulder dystocia cases, specifically the recording of the exact shoulder dystocia duration in seconds. Secondary outcomes included evaluation of the documentation of shoulder dystocia maneuvers and a pre-and post-simulation knowledge test. Included in this test were questions from the validated survey, the Safety Attitudes Questionnaire, a tool focused on evaluating team dynamics and communication. It was hypothesized that this simulation would improve communication as shown by sustained improvement in documentation, competence in shoulder dystocia care, and confidence among members of the team as shown by improved scores on the Safety Attitudes Questionnaire. STUDY DESIGN: This was a retrospective cohort study of shoulder dystocia cases from 2017 and 2019 at a safety-net tertiary care hospital, 1 full year before and after the implementation of a multidisciplinary shoulder dystocia simulation in 2018. Delivery outcomes were compared, documentation of delivery event times was recorded and analyzed, and the delivery note was evaluated using the American College of Obstetricians and Gynecologists guidelines for shoulder dystocia. The surveys from participants were assessed for postsimulation improvement.Categorical variables were analyzed using chi-square tests and continuous variables were compared using Student t tests. Because shoulder dystocia duration is a nonparametric variable, this was compared using a Kruskal-Wallis test. RESULTS: There were 28 cases in the 2017 cohort and 25 in the 2019 cohort. In the 2017 cohort, 25% of delivery documentation (7 of 25) included the exact shoulder dystocia duration, which increased to 96% (24 of 25) in the 2019 cohort (P<.001). There was no significant impact on the shoulder dystocia duration (P=.163). On average, 2.7 maneuvers were required in the 2017 cohort, which increased to 3.4 maneuvers used in the 2019 cohort, showing a significant increase in the use of shoulder dystocia maneuvers (P=.030). The posttests showed no impact on shoulder dystocia background knowledge (P=.142) or knowledge of risk factors (P=.171) but did show an increased understanding of the definition and performance of shoulder dystocia maneuvers (P=.008). The Safety Attitudes Questionnaire revealed that simulation participants would feel safe being treated by their colleagu...

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“…Furthermore, medical documentation of the diagnosis-to-delivery time and obstetrical maneuvers must be accurate, considering maternal counseling following SD and precautions in subsequent pregnancies. Olson et al recently reported a strong correlation between shoulder dystocia training and improved clinical documentation, patient counseling, and communication skills among healthcare providers 29 . Communication skills are significantly correlated with improved clinical performance, suggesting that teamwork improves clinical outcomes in emergencies 30 .…”

Are residents confident to manage shoulder dystocia?

“…In this study, we found that residents reported receiving ~ 17 ~ adequate didactic training on the management of shoulder dystocia, however, this did not translate to feelings of independent clinical competence. In the current educational system for residents, simulation and drills have become a proxy for clinical exposure to infrequent obstetric events [10] . The American College of OB/GYN currently advocates for simulation exercises in an attempt to reduce the complications associated with shoulder dystocia [11] .…”

Shoulder Dystocia: A Comprehensive Literature Review on Diagnosis, Prevention, Complications, Prognosis, and Management

“…The pH in the fetal circulation decreases by 0.01–0.04 units/min. In general, the obstetrician typically has approximately 5 min, assuming the fetus is well-oxygenated, before the risk of severe hypoxia arises [ 2 , 33 , 34 , 35 ].…”