Obstetric emergencies training and the impact for interprofessional teamwork

Martina Gisin, Midwife expert MSc, BSc, RM

Kyiv 19-20 March 2015

Content

• Obstetric emergencies training – why?

• Incidence maternal of morbidity

• Incidence neonatal of mortality

• Obstetric emergencies training - evidence

• Teamwork

• Impact for interprofessional teamwork

• Example: training session PPH

• Summary

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Obstetric emergencies training- why? I

• Obstetric emergencies are rare, and usually unexpected

• Complications in 1 of 12 deliveries

• High risk situations (high perinatal morbidity and mortality for mother and baby)

• Confusion in the team roles and responsibilities

• Faulty clinical tasks

• Inadequate communication

• Ideal framework to train for critical situations in a safe environment without any risks to patients

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Obstetric emergencies training- why? II

• To improve:

Maternal and perinatal care

Outcomes

Teamwork

Communication

Team roles and responsibilities

Situational awareness

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Increase of the incidence of maternal morbidity 1998 - 2009 • Acute renal failure 3,5 fold increasing rate

• Acute myocardial infarction 2,5 fold increasing rate

• Shock 2,5 fold increasing rate

• Sepsis 1,5 fold increasing rate

• Blood transfusions 1,8 fold increasing rate

(Callaghan et al. 2013)

• PPH (Post partum Haemorrhage) – 27% increase 2000 - 2009 (Mehrabadi et al. 2012)

• PPH is the primary cause of maternal morbidity and mortality. Prevalence: 0.5 - 5% (Surbek et al.2009)

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Incidence of neonatal mortality

• Worldwide: 23% of neonatal deaths are intrapartum related – the incidence is increasing

• England, Wales und Northern Ireland 1993 - 1999 – incidence is decreasing

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Obstetric emergencies training- evidence I

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PROMPT

Obstetric emergencies training- evidence II

• Potentially avoidable:

- 50% of all maternal deaths

- 75% of all intrapartum deaths

• Recurrent source of error:

Not identifying the problem Communication failures Delay in reacting to changed clinical circumstances or failure to recognise a change Delayed or failure to transfer the patient Inappropriate delegation to an inexperienced assistant Lack of multiprofessional team working

(CEMACH 2011, CESDI 2007)

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interprofessional

midwife obstetrician

anaesthetists

neonatologist

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Interprofessional collaboration=Teamwork

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Teamwork

• Correct and clear communication can be life-saving

in emergency situations

• It is important to know the different roles and

responsibilities of team members, and to accept and

to respect them

• A team is only as strong as its weakest link and so

its important that all staff are trained

• To take a step back (helicopter view) to get a better

overview

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Impact of interprofessional teamwork- I SaFE study (Simulation and Fire drill Evaluation) researched the: • Effect of training on individuals and the team • Ability of labor staff to manage acute obstetric emergencies • Local vs. centre-based simulation training

Result: • Clear improvement after skills trainings

Conclusion: • Training verified, improved knowledge and performance • Similar improvement between local training units or

simulation centers • Improvement of knowledge and skills persist for 1 year

(Strachan et al. 2011)

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Impact of interprofessional teamwork- II Comparison of teams with or without training in a medical simulation centre:

• Team performance and medical technical skills may be significantly improved after interprofessional obstetric team training in a medical simulation centre. (Fransen et al. 2012)

Sustainability of the training:

• Strengthening the competences in obstetric emergencies situations

• Strengthening sustainably of professional expertise (subjective view)

• Major change was the optimization of communication (Monod et al. 2011)

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Train together who work together

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Example: training session PPH- I

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Example: training session PPH- II

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Example: training session PPH- III

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Summary

• Obstetric emergencies are rare, and mainly unexpected.

Adequate action from all team members is required

• Critical situations and algorithms can be trained for in a

safe environment without any risk to patients

• The subject-specific competences can be strengthened

sustainably and can improve maternal and perinatal

care in the emergency situation

• «Train together those who work together», a concept of

interprofessional collaboration to improve the safety of

patients in obstetrics and in many other areas 18

Basel Simulation team for obstetric emergencies

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Literature • Callaghan WM, Creanga AA, Kuklina EV (2012) Severe maternal morbidity among delivery and postpartum

hospitalizations in the United States. American Journal of Obstetrics & Gynecology, 120(5):1029-36.

• CEMACH, CESDI & NCEPOD (2011) 8th Annual report of the Confidential Enquiries in to maternal deaths in the UK Clinical Negligence Scheme for Trusts.

• Confidential Enquiry into Stillbirths and Deaths in Infancy (2007)8th Annual report. Focusing on: Stillbirths. European Comparisons of Perinatal Care. Paediatric Postmortem Issues. Survival Rates of Premature Babies – Project 27/28.http://www.bmj.com/content/bmj/suppl/2012/04/03/bmj.e2105.DC1/galc002312.ww2_default.pdf

• Fransen et al. (2012) Effect of obstetric team training on team performance and medical technical skills: a randomised controlled trial BJOG An International Journal of Obstetrics and Gynaecology, 119 (11): 1387- 1393.

• Lawn JL, Kinney M, Lee AAC, Chopra M, Donnay F, Paul VK, Bhutta ZA, Bateman M, Darmstadt GL (2009) Reducing intrapartum-related deaths and disability: Can the health system deliver? International Journal of Gynecology & Obstetrics, 107:123–142.

• Mehrabadi A, Hutcheon JA, Lee L, Liston RM, Joseph KM (2012) Trends in postpartum hemorrhage from 2000 to 2009: a population-based study. BMC Pregnancy and Childbirth, 12:108.

• Monod C., Vökt C., Gisin M., Gisin S., Hösli I. (2011) Simulationstraining in der Geburtshilfe: Erfahrungen am Universitätsspital Basel, Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe SGGG, Jahreskongress in Lugano.

• Strachan B, Crofts J, James M, Akande V, Hunt L, Ellis D, Harris M, Montague I, Draycott T (2008) Proof of principle study of the effect of individual and team drill on the ability of labour ward staff to manage acute obstetric emergencies. Edgbaston, Birmingham: PSRP, Department of Health, Public Health, Epidemiology & Biostatistics, University of Birmingham

• Surbek D, Hess T, Drack G (2009) Aktuelle Therapieoptionen der postpartalen Hämorrhagie (aktualisierte Version vom 3.11.2009). Expertenbrief No. 26, Kommission Qualitätssicherung Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe. http://sggg.ch/files/Expertenbrief_No_26.pdf.

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