With close to 200 employees and 5000 deliveries a year, the hospital’s obstetric department ranges among Norway’s three busiest.

Patient safety

SUS_Assessing the fetal heart during second stage of laborAssessing the fetal heart
during second stage of labor.

The unit had employed skills training for some time when practice development midwife Signe Egenberg wanted to extend the training by integrating full scale simulations in multidisciplinary teams and also provide training on a more frequent basis.

As Egenberg puts it, ''multi-disciplinary training is crucial for safe handling of real emergency situations.''

Rural health clinics and large hospitals need the same training

SUS_Cutting the umbilical cordCutting the umbilical cord.

With previous experience as a midwife in rural Norway, Signe Egenberg knows only too well that a successful outcome of an emergency situation totally depends on whether the healthcare professionals know exactly what to do and whether the team in charge is able to coordinate the appropriate care actions efficiently.

Though larger hospitals are usually far better off in terms of personnel and equipment, the need for prompt and correct action in emergency situations stays the same.

How the simulation training is set up

1. Skills training at the hospital: Every 12 weeks a new group of midwives and care assistants are taken out of their ordinary work plan for one training day that comprises lectures on relevant subjects and subsequent skills training. Hence, all midwives and healthcare assistants have four such training days each year.

2. In situ simulations in multidisciplinary teams are facilitated on a monthly basis where midwives, pediatricians and healthcare assistants train together. Each session lasts approximately one hour and the training takes place on various wards around the hospital.

3. Multidisciplinary team training at the simulation center is facilitated three days in a row in the fall, where nearly 200 midwives, gynecologists, care assistants, and nurses train together. Three to four different scenarios are run in parallel until each group has been exposed to all of them.         

4. Facilitated debriefing follows every simulation scenario and these sessions last ca 30 minutes. To ensure the participants have a good experience, the facilitators focus primarily on the positive aspects of their performance. When addressing some of the challenges, the focus is rather on the roles than on the individuals in question.

Experience so far

SUS_Signe EgenbergSigne Egenberg says the training also 
helps the unit improve their protocols.

Signe Egenberg says ''the multidisciplinary simulation training is perceived as very realistic and participants are able to apply what they learned to real clinical emergency situations from day one.''

She points out that the enhanced clinical skills along with an improved ability to collaborate and communicate helps team members stay calmer during stressful emergency situations at the hospital.

''Moreover, the various roles and responsibilities are clearer now and individuals have greater confidence that they can handle challenging situations.''

Frequently used scenarios:

SUS_A postnatal examination is performed to ensure the entire placenta is expelledA postnatal examination of the placenta is
performed to ensure the entire placenta is expelled.

Asphyxia, Respiratory arrest, Cardiac arrest, Post-partum hemorrhage, Shoulder dystocia, Vacuum delivery, Forceps delivery, Pre-shock, Neonatal resus-citation, Breech presentation, Eclampsia and Breast feeding difficulties.