Validating Obstetric Emergency Checklists using Simulation: A Randomized Controlled Trial

Komal Bajaj; Enid Y. Rivera-Chiauzzi; Colleen Lee; Cynthia Shepard; Peter S. Bernstein; Tanya Moore-Murray; Heather Smith; Lisa Nathan; Katie Walker; Cynthia Chazotte; Dena Goffman

doi:10.1055/s-0036-1586118

American Journal of Perinatology, Table of Contents

Am J Perinatol 2016; 33(12): 1182-1190
DOI: 10.1055/s-0036-1586118

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Validating Obstetric Emergency Checklists using Simulation: A Randomized Controlled Trial

Authors

Komal Bajaj

¹Department of Obstetrics and Gynecology, Jacobi Medical Center, New York City Health + Hospitals, Bronx, New York

²Simulation Center, New York City Health + Hospitals, Bronx, New York

³Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
Enid Y. Rivera-Chiauzzi

³Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
Colleen Lee

³Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
Cynthia Shepard

³Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
Peter S. Bernstein

³Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
Tanya Moore-Murray

³Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
Heather Smith

³Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
Lisa Nathan

³Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
Katie Walker

²Simulation Center, New York City Health + Hospitals, Bronx, New York
Cynthia Chazotte

³Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
Dena Goffman

⁴Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York

Abstract

Background The World Health Organization's Surgical Safety Checklist has demonstrated significant reduction in surgical morbidity. The American Congress of Obstetricians and Gynecologists District II Safe Motherhood Initiative (SMI) safety bundles include eclampsia and postpartum hemorrhage (PPH) checklists.

Objective To determine whether use of the SMI checklists during simulated obstetric emergencies improved completion of critical actions and to elicit feedback to facilitate checklist revision.

Study Design During this randomized controlled trial, teams were assigned to use a checklist during one of two emergencies: eclampsia and PPH. Raters scored teams on critical step completion. Feedback was elicited through structured debriefing.

Results In total, 30 teams completed 60 scenarios. For eclampsia, trends toward higher completion were noted for blood pressure and airway management. For PPH, trends toward higher completion rates were noted for PPH stage assessment and fundal massage. Feedback resulted in substantial checklist revision. Participants were enthusiastic about using checklists in a clinical emergency.

Conclusion Despite trends toward higher rates of completion of critical tasks, teams using checklists did not approach 100% task completion. Teams were interested in the application of checklists and provided feedback necessary to substantially revise the checklists. Intensive implementation planning and training in use of the revised checklists will result in improved patient outcomes.

Keywords

checklist - eclampsia - maternal hemorrhage - safety - simulation

Full Text

References

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