Simulation Turning A Team of EXPERTS Into an EXPERT TEAM! M. Hellen Rodriguez M.D. Jeff Mackenzie R.N.
Contributors to Maternal M&M from Obstetrical Hemorrhage DELAY IN DIAGNOSIS DELAY IN BLOOD TRANSFUSION DELAY IN RETURN TO THE OR
Contributors to Maternal M&M from Obstetrical Hemorrhage COMMUNICATION ERRORS DEVIATION FROM ESTABLISHED GUIDELINES LACK OF COORDINATION BETWEEN DEPARTMENTS
Communication Breakdowns are frequently the root cause of undesirable outcomes
Average Rate of Errors Avg. Length of Stay (days) Team Training with Simulation has Proven Results 35 30 25 20 ED Observed Errors 55% Reduction Exp Control 2.4 2.2 2 1.8 Length of ICU Stay After Team Training 50% Reduction 15 1.6 10 5 0 Pre-Teamwork Post-Teamwork Training Training (Morey, 2002), Dynamics Research Corporation Health Services Research OR Teamwork Climate and Postoperative Sepsis Rates (per 1000 discharges) 18 16 14 12 Group Mean AHRQ National Average 10 8 Low Teamwork Climate Mid Teamwork 6 Climate 4 High Teamwork Climate 2 0 Teamwork Climate Based on Safety Attitudes Questionnaire (Sexton, 2006), Johns Hopkins Low High 1.4 1.2 1 June July August Sept Oct Nov Dec Jan Feb March April May (Pronovost, 2003), Johns Hopkins Journal of Critical Care Medicine L&D Adverse Outcomes (Weighted Adverse Outcome Score) 50% Reduction (Mann, 2002), Beth Israel Deaconess Medical Center Contemporary OB/GYN 2013 Pomona Valley Hospital Medical Center 6
Medical Simulation PATIENT CARE SCENARIOS WHICH ALLOW MULTIDISCIPLINARY TEAMS OF HEALTHCARE PROFESSIONALS TO PRACTICE EVIDENCE BASED CARE GUIDELINES, IMPROVING COMPETENCE AND CONFIDENCE, AS WELL AS TEAM COMMUNICATION IN DELIVERING HIGH-QUALITY PATIENT CARE. NO THREATS TO PATIENT SAFETY REALISTIC SITUATIONS DEBRIEFING ASSISTS THE TEAM IN COMMUNICATION SKILLS, DECISION * WEBER, 2013 MAKING, PROTOCOLS, TEAMWORK AND OTHER VARIABLES*
Goals of Simulation Enable the healthcare team to train for high risk events that are relatively rare. Enhance and promote patient safety and quality healthcare by improving teamwork and communication. Enhance clinical competence by providing individuals with opportunities for repetition, pattern recognition and faster decision making so when faced with a real situation habit takes over. One person is not responsible, THE TEAM IS! 2013 Pomona Valley Hospital Medical Center 8
Simulation General Goals Effective communication with patient Closed-loop team communication Focused patient assessment Ability to develop an appropriate differential diagnosis Ability to develop an appropriate management plan
Post Partum Hemorrhage Specific Goals Recognition of deteriorating vital signs Objective evaluation of blood loss Acquisition of appropriate lab tests Appropriate use of uterotonic medications Establishment of2 IV's and fluid resuscitation Institution of the Massive Transfusion Protocol Appropriate use of uterine tamponade balloon or B- lynch suture Timely return to the OR
Questions for Su-Yen and her Team
Postpartum Hemorrhage Simulation Agenda Welcome Pretest review CMQCC toolkit and guidelines Introduction to simulation Goals Familiarization with the simulators Familiarization with the Bakri balloon Scenario/debrief x2 Objective evaluation
The Experience Mistakes will happen Keep as close to reality as possible Our own MDs involved The environment is key Experiential Learning
References Bingham, D., Melsop, K., Main, E. (2010). CMQCC Obstetric Hemorrhage Hospital Level Implementation Guide. The California Maternal Quality Care Collaborative (CMQCC). Stanford University, Palo Alto, CA. Weber, J.G., MBA, MPAS, PA-C, from, http://nurse-practitioners-and- physician-assistants.advanceweb.com/features/articles/medical- Simulation.aspx Morey 2002, Dynamics research corporation. Health services research. Mann, 2002. Beth Israel Deaconness Medical Center. Contemporary ObGyn. Provonost 2003, John Hopkins Journal of Critical Care. 2013 Pomona Valley Hospital Medical Center 14
Simulation Turning A Team of EXPERTS Into an EXPERT TEAM!