Multidisciplinary in situ simulation to improve emergency obstetric care

Brolinson, Marja; Tondo-Steele, Katelyn; Chan, Miriam; Gable, Brad

doi:10.1136/bmjstel-2019-000488

Cited by 4 publications

(3 citation statements)

References 7 publications

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“…The lack of significance in the objectives focusing on MTP, prioritization of care for pregnancy-related hemoperitoneum with shock, and decision-making in pregnancy-related trauma for the physician group likely reflects a higher initial comfort level with those objectives. Perhaps in part due to the frequent education residents receive regarding these topics [ 18 , 20 ]. While not statistically significant, all these objectives did show improved confidence for physician learners.…”

Section: Discussionmentioning

confidence: 99%

“…In-situ simulations have shown to be effective teaching methods for high-risk, low-frequency clinical scenarios so that learners have exposure to these situations and can learn from mistakes without compromising patient care. Pregnancy-related trauma and emergent cesarean sections are two areas where simulation scenarios have proven to be effective [8,[16][17][18]. Introducing multiple disciplines to a simulation can help improve communication and inter-departmental perceptions [19,20].…”

Section: Introductionmentioning

confidence: 99%

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Multidisciplinary Simulation of Trauma in Pregnancy with Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Utilization

Hopmann¹,

Varre²,

Duncan³

et al. 2022

Cureus

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BackgroundStudies have demonstrated the use of resuscitative endovascular balloon occlusion catheters of the aorta (REBOA) in the setting of postpartum hemorrhage and traumatic hemorrhagic shock. However, REBOA is infrequently utilized leading to a lack of clinician comfort. This study's aim was to demonstrate the utility of REBOA in a hemorrhaging pregnant trauma patient and improve clinician comfort with the placement of REBOA while emphasizing collaboration between medical specialties. MethodsA multidisciplinary in-situ simulation was developed for the management of a pregnant patient with an abdominal gunshot wound evaluated by obstetrics and surgery teams. A trauma survey, emergency csection, massive transfusion protocol (MTP), and evaluation for and placement of REBOA were indicated during the simulation. A standardized Return on Learning questionnaire was utilized to determine participants' reactions and confidence gained during the simulation. ResultsA total of 32 of 41 participants completed the survey (78%). A statistically significant increase in confidence was reported in the ability to prioritize the care of a pregnant patient with hemorrhagic shock (p = 0.016), apply MTP to the appropriate clinical setting (p = 0.03), and analyze critical decisions made for abdominal trauma in pregnant patients (p = 0.006). Specifically for physicians, a significant increase in confidence in the ability to identify indications/contraindications for REBOA placement in hemorrhaging patients was observed (p = 0.021). ConclusionsA multidisciplinary simulation for the management of a pregnant patient in hemorrhagic shock secondary to penetrating abdominal trauma improved learner confidence in MTP, care of pregnant patients in hemorrhagic shock, and abdominal trauma in pregnancy. Physician learners gained confidence in indications for REBOA placement in abdominal trauma. This simulation was highly relevant to all participants.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Multidisciplinary Simulation of Trauma in Pregnancy with Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Utilization

Hopmann¹,

Varre²,

Duncan³

et al. 2022

Cureus

View full text Add to dashboard Cite

show abstract

“…This case report highlighted the importance of a multidisciplinary approach in managing this rare, but life-threatening condition. We have previously described multidisciplinary education involving severely injured pregnant trauma patients [ 8 ]. We sought to evaluate a different low-frequency high-risk situation with this scenario.…”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary Simulation Improves Resident Confidence for Pregnant Patients Requiring Surgical Intervention

Harrington¹,

Duncan²,

DAngelo³

et al. 2022

Cureus

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Introduction: Hepatocellular adenomas are a rare but serious cause of bleeding, which is further complicated by pregnancy. Interprofessional cooperation is a key component of residency education, thus simulations designed to integrate multiple programs are mutually beneficial. This simulation details surgical and obstetric management of a pregnant patient in hemorrhagic shock from a bleeding hepatocellular adenoma. Objectives for the study were to evaluate learners’ confidence to 1) prioritize the care of a pregnant patient with hemoperitoneum and hemorrhagic shock, 2) demonstrate interdisciplinary collaboration with other specialties, 3) apply massive transfusion protocol (MTP) in the appropriate clinical setting, and 4) analyze critical decisions for evaluating pregnant females with severe abdominal pain. Methods: Obstetric, general surgery, and anesthesia residents, along with labor and delivery nurses participated in a simulated clinical scenario that focused on the management of a pregnant patient in hemorrhagic shock. The learners evaluated the educational session using a standard Return on Investment in Learning survey immediately following the session. Results: A total of 23 residents and medical students gave feedback on the experience. The main learning objectives were met with increased confidence in the four learning objectives by 77.3-95.4% of responders. Overall, greater than 90% of participants felt the simulation was relevant to their training and realistic, with 100% responding that the course provided new, or clarified existing information for them. Conclusion: A multidisciplinary simulation-based educational intervention was successful in improving learner confidence in managing a complicated surgical emergency in a pregnant patient with inter-residency cooperation.

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Maternity Nursing

Bryant,

Greenawalt

2023

Comprehensive Healthcare Simulation

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Multidisciplinary in situ simulation to improve emergency obstetric care

Cited by 4 publications

References 7 publications

Multidisciplinary Simulation of Trauma in Pregnancy with Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Utilization

Multidisciplinary Simulation of Trauma in Pregnancy with Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Utilization

Multidisciplinary Simulation Improves Resident Confidence for Pregnant Patients Requiring Surgical Intervention

Maternity Nursing

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