How does simulation build readiness for OB emergencies?
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How can simulation help providers prepare for OB emergencies?
This video contains expert insights on how simulation can help providers prepare for OB emergencies. You may also read the transcript below.
Roxane Gardner, MD, MSHPEd, DSc
Executive Director, Center for Medical Simulation
Assistant Professor-Obstetrics, Gynecology at Harvard Medical School
Department of OB/GYN at Brigham and Women’s Hospital
Division of Adolescent Gynecology at Boston Children’s Hospital
Department of Anesthesia, Critical Care and Pain Medicine at Massachusetts General Hospital
Dr. Gardner: “I’ve been involved in OB simulation ever since 2001. That was at a time in which we were doing hardly anything in simulation in the obstetrical arena. I was very fortunate to be part of that in our Boston medical community. We were supported by our Harvard Medical malpractice company, CRICO. They had seen the value that simulation had brought to anesthesia in diminishing the frequency of malpractice claims. … Because of the signs and the trends that they were seeing within the anesthesia world, they decided to support us in the obstetrical world.
I was on the ground level of creating a communication and teamwork course for obstetrical teams. We worked on things like shoulder dystocia: understanding better how to organize the team, how to communicate with each other in a more explicit way, helping people not to be afraid to say the words ‘shoulder dystocia’ – which, if you say it out loud, then other people in the room are going to know, ‘this is what we need to do’ and start to be able to help you sooner.
The same goes for postpartum hemorrhage. Postpartum hemorrhage is one of those scenarios in real life that can sneak up on you. Sometimes it’s catastrophic – you know exactly what’s going on. But there are times, more often than not, where the bleeding is just kind of slowly trickling and then builds up. And before you know it, enough time has lapsed that somebody has really lost a tremendous amount of blood.
“[Simulation provides clinicians with] opportunities to be involved in those kinds of standardized type scenarios and get a chance to work with other members in their team to recognize the situation earlier, to implement therapies earlier, or to call for help earlier. And then, [they] have a chance to debrief and talk about ways in which the situation could have been managed better.”
What went well? How could we do better next time? Then, try another case – a different version of postpartum hemorrhage, so to speak. There’s just a multitude of other kinds of things that happen. It doesn’t have to be something that’s relegated to the labor floor. It could be something that happens in postpartum. It could be a collapse of a woman in the bathroom [from] a vasovagal. Or it could be she has a seizure from elevated blood pressure, [which] we call preeclampsia and eclampsia.
One interesting situation which we actually had happen in our in our medical area, was we had episodes of babies that were dropped by accident. Looking at what had happened, they were situations in which the mother was a little bit too sleepy. After cesarean section, somebody turned their head and wasn’t paying attention to her – and the baby fell off the bed.
A few varieties of those kinds of things allowed us came to our attention, and we were able to incorporate that into our sims so that it heightened awareness around the things that we need to be mindful of with our patients who have just delivered.”
