Shoulder Dystocia (SD) is a serious obstetric emergency with the potential for serious harm to both mother and baby. SD injuries are among the top four reasons for obstetric litigation in the U.S.. At Allina, incidences of SD comprised only 2½ - 3% of region-wide births in 2007, and medical professionals felt inadequately prepared for this emergency event.
Optimal maternal and fetal outcomes are attainable when obstetric teams understand SD and its mechanisms. A clear management plan, established teamwork and communication processes can dramatically decrease potential for harm.
Allina introduced simulation-based obstetrics training focused on SD to allow medical staff and nurses to practice the skills and interventions required for successful deliveries.
Fetal force monitoring system offers positive feedback
In 2007, Allina purchased one PROMPT Birthing Simulator to initiate a 90-120 minute training program at one metro hospital. It featured two short films – “Risk Factors” from the American College of Obstetricians and Gynecologists (ACOG) and “Advanced Life Support in Obstetrics” from American Academy of Family Physicians (AAFP) on Advanced Life Support in Obstetrics (ALSO) – a literature review of SD and other adverse obstetrical events for information and discussion, and a ’hands-on’ training using the PROMPT Birthing Simulator with Force Monitor system.
Each class included physicians and nurses with roles clearly defined. All were urged to communicate and act as they would in real-life situations.
During the ‘hands-on’ training, the PROMPT Birthing Simulator was set up in a delivery room. Hybrid simulation, with a nurse acting as the mother by sitting in the bed behind the simulator, enhanced the realism of the clinical environment. The “mother” held the baby in the birth canal and the force monitor device measured how much pressure physicians applied to the baby during delivery. All participants delivered the baby in different maneuvers and scenarios, including normal delivery, breech, vacuum, forceps and SD.
“Physicians were extremely interested in whether they were pulling too hard,” said Kitty Haight, BS, RN, Performance Improvement Consultant for Allina. “They delivered as they normally would and we provided feedback.”
Simulation training improves quality & speed of response to SD & other birthing complexities
Data showed statistically significant decreases in adverse events:
- In 2007, 10.5% of all babies with SD had an APGAR score of <7 at 5 minutes. In 2009, only 1.2% were scored below 7
- Maternal hemorrhage following a SD delivery reduced from 10% to 6.7%
- Additional improvements were noted in the numbers of brachial plexus injuries and uterine rupture
- One site review of all SD cases showed a decrease in time (from over three minutes to one minute or less) from identification of SD to delivery of the baby
“We clearly attribute this to the training we’ve done,” said Haight. “People feel more confident and there’s improved teamwork.”
Physicians give high marks to hands-on training program
Allina now has five PROMPT Simulators placed in three metro hospitals and at corporate offices for regional training use. The Allina Pregnancy Care Council strongly promotes and encourages participation in the training; some hospitals mandate it for credentialing programs.
Even initially resistant physicians strongly endorsed the program. And, on a scale of 1 to 5 (with 5 being the highest), all participants gave 4’s and 5’s, citing the hands-on training as particularly beneficial. Many said, “this was the best class I’ve been to in years.”
“The data is dramatic,” said Haight. “We’re strong believers. It has worked out very well for us.”