Simulation Training: One Obstetrician's Perspective
Mary-Lou A. Misrahy, ARM, President and CEO
This quarter I wanted members to learn more about how Physicians Insurance is leading the way for Northwest physicians through our simulation training. Dr. Chien’s experience made such a positive impression on her and her colleagues that my column is devoted to her firsthand account. It is my hope that more of our members discover the value of simulation training—and thereby benefit from improved patient safety and safer physician practices.
Angela Chien, MD, practices obstetrics and gynecology at Evergreen Women’s Health Center in Bellevue, Washington.
Shoulder dystocia. Postpartum hemorrhage. Eclampsia. These are all examples of obstetrical emergencies that are infrequently encountered. But when they occur, the heart rate of the obstetrician is often well above that of the patient. There is no question that these emergencies require the best of teamwork for positive outcomes. The challenge comes in that every time these crises occur, there is a unique team of staff and providers working together—and almost always a team that has never worked together before.
In the fall of 2010, while attending training in patient safety through the Institute for Healthcare Improvement, I had an epiphany: My hospital needed to start performing regular simulation training. It became clear that delivering obstetrical care relies not only on well-meaning people, but even more so on adequate systems and protocols being in place to deal with emergencies. While we had run simulations in the past, these were infrequent events, and not mandatory for staff or providers. Frankly, it was hard to determine if the simulations were making a difference in patient safety. My first step was to gather a group of nurses, providers, and leaders in the department who were interested in team training and equally committed to patient safety. I then contacted Physicians Insurance through a claims representative I had worked with before, and they connected me to support through the Risk Management Department.
Physicians Insurance was no stranger to simulation. As part of their robust efforts in providing education for their insureds, they had sponsored simulation training at different institutions in Washington. With their help, I was able to observe simulation of a postpartum hemorrhage in Seattle. Within the next few months Physicians Insurance was sponsoring shoulder dystocia drills at Evergreen Hospital. The process was seamless for us—we just had to make sure that staff and providers attended. As part of the implementation process, Physicians Insurance also made sure that those who participated would receive continuing education credits. Additionally, Physicians Insurance prepared surveys for all participants.
The first day of simulation felt like Christmas morning—having the ability to simulate shoulder dystocia and practice the maneuvers was truly a gift. For many of our staff, this was their first simulation experience that involved providers and other staff members in addition to a staff member serving as a patient. The response was overwhelmingly positive. It was clear that simulation was something worth doing for every obstetrical emergency.
This initial simulation training was followed eight months later by emergency Cesarean section drills. Again, we partnered with Physicians Insurance in these efforts. Based on the feedback after these first two sets of drills, we have been able to convince our administration that simulation training needs to be part of the annual budget and needs to be mandatory for everyone involved in providing obstetrical care.
We now have a department that is committed to simulation training. At our recent Patient Safety Summit, drills were touted as one of the best safety practices we have implemented in the last year. Moving forward, we plan to provide mandatory simulation training three times a year, covering every obstetrical emergency at least once during that cycle. To support our efforts we will gather data on outcomes, feeling certain that we will show improved outcomes as a result of this team training.
Did the training make a difference? Yes. Just one week after postpartum hemorrhage drills, I had an actual patient who suffered from significant bleeding after a scheduled Cesarean section. My team worked beautifully and they were confident in their abilities to help care for this patient. I utilized a technique I had never used before the simulation training—employing a tamponade balloon—and was able to stop the bleeding. As a team, we were able to save the patient while avoiding more extensive surgery or an ICU admission.
Simulation training definitely requires work on the part of each institution. Though we receive guidance from experts in the simulation, we have developed protocols that are specific to our institution. Following every set of drills, we discover things that need to be changed and practiced again. In the end, it is well worth the effort and I would encourage every hospital providing obstetrical care to embark on this journey.