The Mobile Obstetric Emergencies Simulator: Integrating TeamSTEPPS And Simulation To Improve Patient

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The Mobile Obstetric Emergencies Simulator
Integrating TeamSTEPPS And Simulation To Improve
Patient Safety
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ANDERSEN SIMULATION CENTER

• Located at Fort Lewis with Madigan Army Medical
  Center
• DoD Team Resource Center (Designated as a Center
  of Excellence by TMA)
• Only DoD Educational Institution Accredited by
  the American College of Surgeons
• Headquarters for the Army Central Simulation
  Committee

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OUTLINE

• Bottom Line
• Patient Safety and Evidence for Obstetric
  Simulation
• TeamSTEPPS
• Mobile Obstetric Emergencies Simulator
• Conclusion

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BOTTOM LINE

• Simulation training for Obstetrics should be
  performed on the actual LD unit and address both
  Teamwork and Technical performance
• Simulation for emergencies is a critical step to
  improving patient safety
• The Mobile Obstetric Emergencies Simulator is an
  inexpensive and powerful tool to accomplish this
  mission

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PATIENT SAFETY

• Up to 98,000 die in the U.S. each year from
  medical mistakes.
• (To Err is Human, 1999)
• 1997 report from England/Wales/N. Ireland
  reported on all perinatal deaths over a 5 year
  period. (Johanson, 1999)
• Suboptimal care reported in 78
• Estimated at least 50 would have had better
  outcome with improved care.
• Specifically, the report listed the following
  areas where inexperience may be most costly
• Shoulder dystocia
• Operative vaginal deliveries
• Breech vaginal delivery

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DECREASED FETAL INJURY

• All deliveries from 1996-2004 reviewed
• Annual Shoulder Dystocia (SD) training started in
  2000.
• Incidence of SD the same before and after
  training started
• Four-fold reduction in neonatal injuries in
  babies with SD (3.6 after vs 12.8 before, p lt
  0.0001) (Wilson, 2006)

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TEAMWORK AND PATIENT SAFETY

• 1970s Military Inspector General identified
  that 70 of aircraft-related fatalities were
  caused by human error and poor teamwork. (Mann,
  2006)
• 2004 - Joint Commission noted in Sentinel Alert
  that most cases of perinatal injury associated
  with communication among providers.
• Recommended that organizations conduct teamwork
  training in perinatal areas to improve this.

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TeamSTEPPS

• DoD Patient-Centered approach to improving
  Quality and Safety
• Curriculum based on crew resource management
  techniques that attempt to capitalize on the
  ability of each team member to see, analyze, and
  react to situations in ways to reduce the
  potential for error
• Being implemented across the DoD and Civilian
  Community as well

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Mobile OB Emergencies Simulator
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MOBILE OB SIMULATOR

• Started as a sketch drawing about 5 years ago
  after recognizing need for training on actual LD
  unit
• Improved technology available
• Emphasis on integration of Simulation in
  Obstetrics and TeamSTEPPS principles to improve
  Patient Safety
• Funded by TMA in 2006

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MOBILE OB SIMULATOR

• GOALS OF MOBILE OB EMERGENCY SIMULATOR
• Improve patient safety
• Improve teamwork and technical performance
• Identify and correct systems issues unique to
  each LD unit
• Fulfill Joint Commission requirements

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MOBILE OB SIMULATOR

• Create a mobile platform that can accomplish the
  following
• Run simulations on actual LD units
• Provide a standardized curriculum
• Evaluate both Teamwork and Technical proficiency
• Integrate a no-fault debriefing tool
• Provide a mechanism to allow LD units to
  practice and evaluate skills learned in
  TeamSTEPPS training
• Be able to monitor progress over time
• Inexpensive

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MOBILE OB SIMULATOR

• Built prototype here at MAMC 2006-2007
• Designed parts for simulator that did not exist
  (eclampsia model)
• Standardized curriculum written 2006-2007
• Validation of evaluation forms
• TeamSTEPPs principles
• Simulations run on MAMC
• LD beginning June 2007

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MOBILE OB SIMULATOR

• Obstetric emergencies simulated
• Shoulder dystocia
• Postpartum hemorrhage
• Eclampsia
• Emergency cesarean section
• Breech vaginal delivery
• Operative vaginal delivery
• Neonatal Resuscitation
• Incorporates TeamSTEPS training and evaluation
  tools into the scenarios and debriefing

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MOBILE OB SIMULATOR

• Includes the following
• Full size birthing simulator (NOELLE)
• Eclampsia modification
• Birthing fetuses
• Fetal/maternal vital signs monitors
• Mobile cart with video capability
• Audience response system
• Total cost approximately 20,000 per unit

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MOBILE OB SIMULATOR

• Set up and run OB Emergency Simulation
• Conduct TeamSTEPPS debriefing with audience
  response system
• Discuss Best Practices and review opportunities
  for improvement
• Keep data and compare to subsequent drills

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TRAINING CONDUCTED 9/07

• Representatives from the following MTFs
• Bremerton Naval Hospital
• Darnall Army Community Hospital
• Landstuhl Regional Medical Center
• Portsmouth Naval Hospital
• San Diego Naval Hospital
• Tripler Army Medical Center
• Wilford Hall Air Force Medical Center
• WOMAC
• WRAMC/Bethesda Naval Hospital
• Wright Patterson Air Force Medical Center
• Each team put together a Mobile OB Simulator,
• and practiced running scenarios

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MOBILE OB SIMULATOR

• 8 additional Mobile OB Emergencies Simulators
  were shipped to the participating locations
• Pre-implementation survey conducted at each
  location prior to beginning training
• Goal of running 1-2 simulation drills per month
• Will evaluate baseline and post-implementation
  performance at each site

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INITIAL RESULTS

• More than 150 people trained to date (both on LD
  and the Postpartum Unit)
• Overall excellent acceptance and identification
  of both team and personal areas to improve upon
  with each simulation
• Army has applied for patent and potential
  licensing

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COST ANALYSIS

• Mean cost of one settled OB malpractice claim
• 2,500,000

• Cost of Mobile Obstetric Emergencies Simulator
• 20,000

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CONCLUSIONS

• Simulation training is imperative for improving
  patient safety in obstetrics
• It is imperative to address both Teamwork and
  Technical performance during simulations
• Simulation training allows for TeamSTEPPS
  training to be reinforced, practiced, and
  evaluated in a no-risk environment
• The Mobile Obstetric Emergencies Simulator is an
  inexpensive way in which to address these issues