1. Department of Obstetrics and Gynecology
Use of Obstetrical Simulation to Improve Patient Care in High Risk Situations
Project team: Amy Brien MD, Jason DeWitt MD, Phyllis Hartwig RN , Sarah Rucker-Johanson RN and Dianne Setness
Department of Obstetrics and Gynecology
MCHS - SW MN Region
Abstract
Simulation is a tool that has been found useful in training medical personnel to perform a variety of skills required for direct patient care. Simulation can be used to help develop basic skills like starting an IV to complex skills such as performing robotic surgery. It allows trainees to practice in a safe environment and gain experience without harm to actual patients.
Method and Tool
Simulation 1, 2 and 3 Results
Overall Summary
After reviewing the feedback from the unit staff along with the post-session survey results, the Project Team elected to continue to conduct simulation exercises at least three times per year.
Overall, we observed a significant improvement in staff responses to high-risk situations since beginning the simulation program. Hypertensive emergency treatment is initiated promptly and team coordination during STAT cesarean deliveries is much improved.
The Project Team has expanded to include providers and nurses from both New Prague and Fairmont. The new members attended Simulation Training in Rochester and have begun leading simulations at their respective hospitals.
The entire Project Team now works together to develop new scenarios and to coordinate simulations at all three sites. This has helped to standardize care and expectations across the region.
Background:
Hospital Labor and Delivery Units must be prepared to manage routine patient care, emergency care and critical care. We had specific concerns regarding our readiness to manage obstetric hypertensive emergencies and our ability to respond efficiently when STAT cesarean sections were called.
This prompted formation of a project team that was tasked with improving management of these situations. The team’s overarching goal was to reduce the potential for injury or death for both our moms and babies.
Objective:
The Obstetric Simulation Program was designed to help prepare the staff and providers on Labor and Delivery for high risk situations. Program goals centered on preparing the care team to:
Recognize and respond to emergent and/or critical situations promptly
Work in a coordinated manner
Use closed-loop communication
Methods:
Simulation was the process improvement tool chosen to help prepare staff for these high risk situations. The Project Team members received formal training at the Mayo Clinic Simulation Center in Rochester. At the Simulation Center the team learned how to develop simulation scenarios, how to decide which type of simulation trainer to use, how to implement the scenario and, most importantly, how to debrief the participants following the simulations.
The project team conducted simulation exercises three times during the first year. The exercises were conducted at all regional hospitals that provide obstetrical care: Mankato, New Prague and Fairmont. On simulation day, exercises were scheduled every two hours. Each exercise included two high-risk scenarios. The first half hour was dedicated to the simulation, the second half hour was used for debriefing. The participants were asked to complete an online survey consisting of 7 questions about their experience following the simulation.
Results:
Participant satisfaction with the simulation exercises was uniformly high. Overall satisfaction with the process improved with each offering over the course of the year.
Post-simulation Questionnaire (Likert Scale)
Component of Simulation
Our simulation scenarios employed a variety of models. For the post-partum hemorrhage scenario we used a low fidelity pelvic model. During the obstetric hypertensive emergency we used a live actress. We used the high fidelity Noelle model to simulate shoulder dystocia, STAT cesarean delivery, and obstetric code blue.
Post-simulation Survey Results
PPT Scientific Poster_4x4 Blue Template.ppt
I enjoy the OB simulations, and look forward to participating in many more! The more experiences I can have, the better.
I love the simulations. I like getting the chance to work with my co-workers and doctors in a “crisis situation”. As a new OB nurse, it helps me feel more comfortable in real life situations. It gives me a chance to act ur situations, and I feel I learn a lot. I like that the doctors are also involved. It is nice to learn from their perspective as well.
Helped me to obtain a comfort level of being in the OR that I’ve never obtained before.
It was helpful to create these experiences since we can go long periods of time between being in such a situation.
The environment was non-threatening and enhanced learning. I was encouraged to apply the knowledge that I did have and then instructed on what additionally I needed to know.
Feedback from participants
 2013 Mayo Foundation for Medical Education and Research

2. Instructions