Team Performance in High-Fidelity Simulations of Postpartum Hemorrhage Management

INTRODUCTION: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality and presents care teams with unique, time-sensitive challenges. Simulation provides a way to evaluate team performance with no risk to patients. Identification of common errors is important to target training and optimize outcomes. METHODS: High-fidelity simulation exercises were conducted at a national obstetric critical care conference between 2014 and 2019. A simulated case of a PPH preceded by placental abruption was performed by multidisciplinary teams using high-fidelity simulators. Team performance was evaluated using a standardized checklist of key actions, and each item was scored as “not done”, “poorly done”, or “well done”. Descriptive statistics were then compiled for analysis. The study was reviewed and determined to be exempt by the hospital institutional review board. RESULTS: Complete performance data was available for 155 teams. Appropriate diagnosis of etiology of the hemorrhage (uterine atony) and timely recognition of the need for operative management was well done by most teams (91% and 92.3%, respectively). However, a significant number of teams demonstrated poor performance regarding inspection for lacerations (34.2%) and checking for retained products of conception (38.1%). Additionally, poor performance was identified for timely initiation of blood transfusion (11.6%) and activation of a massive transfusion protocol (20.6%). CONCLUSION: Thorough assessment of time-sensitive care interventions revealed specific deficits in team performance of PPH. High-fidelity simulation provides opportunities for exposure to obstetric emergency and may help to both target and determine the effectiveness of trainings designed to address these identified performance gaps.