Enhancing Postpartum Hemorrhage Response Through Multidisciplinary Training
A multidisciplinary on-site postpartum hemorrhage training exercise, combined with structured team debriefing, aims to evaluate hospital protocols, clinical performance, operational readiness, and team communication in healthcare, while also facilitating the real-time identification of system improvements. Below is a project walk-through . . .
Approach
A team of subject matter experts from various specialties, including maternal-fetal medicine, obstetrics, anesthesia, neonatology, transfusion services, and nursing, collaborated to create realistic and accurate case-based scenarios and learning objectives for healthcare provider training. These objectives focused on medical knowledge, patient care, effective communication, and teamwork, emphasizing team communication in healthcare settings. The team utilized TeamSTEPPS, a recognized framework for communication and collaboration, which is widely promoted and implemented as best practice in emergency situations within this leading healthcare system.
The training exercise aimed to educate learners in recognizing and effectively managing obstetric emergencies, such as postpartum hemorrhage, and identifying the need for and activating the massive transfusion protocol while securing blood products.
The scenario incorporated branching storylines, created with wireframing software, that played out on an obstetrical mannequin simulator (Gaumard Scientific, Miami, FL). Before the exercises began, observers received training on debriefing using the advocacy-inquiry method. To ensure a positive learning environment, all participants were informed upfront that the simulations were for quality improvement and skill development.
Implementation
The healthcare provider training exercise unfolded in a real labor and delivery room to replicate a realistic setting. Participants faced a simulated postpartum hemorrhage, requiring them to activate our hospital's massive transfusion protocol and obtain blood products (simulated) from the blood bank.
To mimic real-life situations, learners assumed their actual roles within the simulations. Their performance was evaluated by observers from key specialties, including obstetrics, anesthesia, nursing, and pediatrics, using standardized forms. These forms categorized actions into medical skills and assessed team communication in healthcare and teamwork effectiveness.
To evaluate the effectiveness of the obstetric massive transfusion protocol, we incorporated a full blood bank tracer into two simulations. This involved activating the protocol via an overhead announcement to test the system and staff response. Blood bank staff then simulated preparing a complete massive transfusion pack, tracking the time it took with and without a pre-existing type and screen on file for the patient.
Measures
After each simulation, teams participated in a standardized debriefing session focused on enhancing healthcare provider training. This involved discussions on patient care, medical knowledge, teamwork, communication, and identifying opportunities to improve systems or processes. Participants then received targeted instruction on key medical topics, including postpartum hemorrhage training.
To gauge the training's impact, participants anonymously completed voluntary surveys designed to assess the training experience, their comfort level managing case-based scenarios before and after the training, and provided space for feedback and suggestions. We measured provider comfort in managing obstetric emergencies using a 5-point Likert scale (1 = very uncomfortable, 5 = very comfortable).
Additionally, we monitored the number of postpartum hemorrhage cases prior to and following the training to identify any improvement trends at both 6 months and 1 year after the training.
A total of 96 participants underwent the training, achieving an impressive 100% response rate on the voluntary surveys. The majority (70%) were obstetric providers, which included obstetric staff/residents (30%), midwives (7%), and labor and delivery nurses (30%). The remaining participants (20%) were anesthesia providers, all contributing to improvements in team communication in healthcare.
Results
The program led to a significant increase in key practices across all areas, particularly in healthcare provider training. Registered nurse participation in drills skyrocketed from 0% to 92%. Additionally, healthcare providers significantly improved in several critical areas, including:
- Quantifying blood loss (increased from 5% to 45%)
- Performing hemorrhage risk assessments (increased from 10% to 70%)
- Conducting pre-birth and post-birth risk assessments (increased from 2% to 57%)
- Debriefing after drills (increased from 1% to 13%)
These improvements suggest the program's potential to positively impact patient outcomes, particularly in postpartum hemorrhage training. Continued efforts are needed to ensure full implementation across all hospital campuses.
The survey results were overwhelmingly positive, with nearly all participants finding the exercise valuable, especially in evaluating systems and enhancing team communication in healthcare. The simulation highlighted areas for improvement in these aspects for many participants. Both participants and observers expressed a strong desire for more frequent training exercises. Notably, the training environment achieved a high level of realism, with many participants reporting feeling stressed during the hemorrhage scenario. Feedback consistently described the case-based training as highly realistic and engaging.
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