Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Seto MTY (1), Cheung CSY (1), Cheung KW (1), Chan HK (1), Yeung LM (1), Kwok SY (1), Chan E (2), Ng A (2), Lou WO (3), Lui F (2)
Affiliation :
(1)Department of Obstetrics and Gynaecology, (2) Department of Anaesthesia, Pain and Perioperative Medicine, (3) Department of Quality & Safety, Queen Mary Hospital
Introduction :
Obstetric emergencies, including obstetric haemorrhage and amniotic fluid embolism, are some of the leading causes of maternal mortality in Hong Kong. Efficient and high-quality multidisciplinary management can reduce these maternal mortality and morbidity.
In the past years, disruption of in-house training during COVID-19 pandemic and decline in delivery rate made the obstetrics and midwifery team difficult to gain experience for rare emergencies. Simulation offered an opportunity to fill the training gaps to improve team work and communication, and helped staff identify red-flags situations and enhance patient safety initiatives.
Objectives :
(1) To strengthen safe and competent obstetric care by enhancing medical and nursing staff training in handling obstetric emergencies in the labour ward
(2) To enhance communication among multidisciplinary teams (obstetrics and gynaecology medical and nursing staff, and anaesthesiologists)
Methodology :
In 2020, obstetrics simulation training with real-time debriefing was initiated to allow midwives and obstetricians to gain exposure to handle rare obstetrics situations.
From 5/2022, critical care conditions with advanced cardiac life support in obstetrics elements (e.g. maternal collapse) with inclusion of anesthesiology trainee was done to improve multidisciplinary team performance.
From 5/2023, further enrichment of critical care simulation including perimortem Caesarean section allowed proficiency of practice in extremely rare events by obstetric trainees.
Result & Outcome :
Since 11/2020, 11 simulation sessions were conducted and 74 participants (26 doctors and 48 nurses) were trained. High participants’ satisfaction was seen in multidisciplinary and multi-level doctors and nurses.
Improvement in proficiency in handling of complex situations demonstrated by the increased in percentage of candidates with correct answers in the pre-test and post-test (e.g. identification of symptoms of amniotic fluid embolism (87.5% vs 100%), recurrent convulsion treatment (60% vs 100%), signs of magnesium toxicity (18.8% vs 25%) and management of severe hypertension in women with pre-eclampsia (12.5% vs 50%)).
Team briefing before major obstetrics operation including ultra-urgent situations or complex operation is adopted from feedbacks from simulation training to enhance team communication since 7/2022.
Conclusions:
Obstetric simulation training sessions improved team performance and communication. Feedback from simulation could also help to enhance team behaviour in real clinical practice.
