183: High Fidelity Simulation Results in Improving Clinician Performance in the Management of Massive Hemorrhage Cases

A massive haemorrhage can be a rare but serious complication of paediatric trauma and obstetrical cases. In order to optimize the management of massive haemorrhages, a protocol was implemented at our centre. However, recent audits showed that necessary improvements were to be made to many aspects of its application. To evaluate the application of a massive hemorrhage protocol and the ability to work in interdisciplinary teams using simulation and targeted training. We also aimed to evaluate confidence levels of different team members to apply the protocol and to hold their role in an interdisciplinary team during a crisis situation. Prospective observational study held at the simulation lab of a tertiary mother-child health care facility. Participants were nurses, respiratory technicians, orderlies, anesthetists, obstetricians, pediatric emergency physicians, pediatric intensivists and hematologists. Pediatric emergency/intensive care and obstetrical/anesthesia teams were submitted to high fidelity simulated pediatric trauma and post-partum massive hemorrhage scenarios respectively (Simbaby (Laerdal) and Noelle (Gaumard)). Each participant was asked to hold their usual role in an interdisciplinary team. Targeted training consisted of a debriefing session and a presentation reviewing the massive hemorrhage protocol as well as teamwork skills. All sessions were videotaped. Documents were given during the first session for future references and to prepare for the post session two weeks later. Confidence questionnaires were filled out during both sessions. Four blinded independent trained raters reviewed the videos and assessment was done using a checklist derived from the protocol and the Mayo High Performance Teamwork Scale. Means and standard deviations of scores for performances were calculated for each scenario and compared using an ANOVA test. Descriptive statistics for the confidence questionnaires were compared using a Mann Whitney test. A total of 62 healthcare professionals involved in eight interdisciplinary teams (four obstetrics/anaesthesia and four paediatric emergency/intensive care) as well as eight blood bank technologists and eight haematologists participated in the study. Following training, scores for the application of the protocol improved by 24% (95% CI 10 to 39). Scores for the ability to work in teams improved by 17% (95% CI 6 to 28). Confidence levels in the ability to apply the protocol and work in teams improved by 13% (95% CI 11 to 16). Targeted training involving HF simulated scenarios and protocol review improved participant ability to apply the massive haemorrhage protocol and to work in interdisciplinary teams. Confidence levels improved among participants from all disciplines.