Team Management for Obstetric Emergencies
Study shows interdisciplinary team training can identify discrepancies in institutional policies
In perinatal units in the United States, communication failures account for 72% of sentinel events (unanticipated events resulting in death or serious injury to a patient, not related to the natural course of the patient's illness). A novel project funded by a GME Innovations Grant from the University of Michigan Medical School Office of Graduate Medical Education examines how simulation-based training can advance patient safety by providing the opportunity to develop clinical competencies around rare or infrequent clinical events. This project, known as OBEMAN, evaluates the impact of an interdisciplinary team training program in Obstetric emergencies on building knowledge and skills among four clinical specialties (Obstetrics, Emergency Medicine, Anesthesiology and Neonatology - OBEMAN).
In the study, recently published in the American Journal of Obstetrics and Gynecology, researchers evaluated the impact of an interdisciplinary team-training program in obstetric emergencies in identifying institutional policies and system-based practices. Teams of physicians, residents, nurses and ancillary health professionals trained in the areas of team-based reasoning and decision-making, communication, management, and follow-up care in the delivery of clinical care for a pregnant patient and her fetus during an emergency event. A web-based reference portal with links to institutional and departmental policies and procedures, state and federal regulations, and professional practice guidelines for each specialty involved in the program was also created.
Under the leadership of Pamela Andreatta, Ph.D., Assistant Professor of Obstetrics and Gynecology and Medical Education, and David Marzano, M.D., Clinical Assistant Professor and Assistant Residency Director of Obstetrics and Gynecology, scenarios were developed to include unusual and challenging cases that explore system-based practices that are seldom evaluated in day-to-day patient care. In addition to issues associated with clinical management, the importance of working collaboratively to determine best practices that would inform systems-level quality improvements were highlighted. All scenarios were designed under the direction of Dr. Andreatta, medical educator, and built around obstetric emergencies presenting to the emergency department designed to require consultation from the participating departments, as well as ancillary specialty services such as respiratory therapy, social work, and SANE (Sexual Assault Nurse Examiner). After each case, participants engaged in debriefing exercises designed to identify and discuss systems-level strengths and challenges, and if warranted, provide recommendations for policy or procedural enhancements.
One of the main issues to be addressed by this program was communication. Dr. Marzano explains, “One of the goals of the program is to empower people who might not feel empowered to speak up.” The motto of the team training is “Don’t be afraid to CUSS!” Team members are urged to verbalize the four statements: “I’m concerned”, “I’m uncomfortable”, “This is not safe”, and “Stop” when they encounter a questionable patient safety experience. Dr. Marzano urges that this program “empowers anyone from the janitor to the chief of staff to speak up.”
Results of the study demonstrate that simulation-based interdisciplinary team training can serve to identify system-based policy discrepancies that remain undiscovered due to the relative infrequency with which they occur. Dr. Andreatta’s analysis of the data yielded five categories of discrepancies between institutional or departmental policy and actual clinical practice. While several studies have documented the benefits of interdisciplinary obstetric team training on improvements in the application of knowledge and skills, the results from this project also demonstrate such interventions are valuable for identifying hidden system-level problems that could adversely impact patient care. Likely, there will always be specialty specific protocols, acronyms, and colloquial phrases; however, interdisciplinary team-based programs may alleviate some of the confusion around their uses in applied practice. Investigators hope that other institutions will do likewise, and collectively a foundation for building a library of best practice guidelines can be established to inform continuous quality monitoring and keep patient safety and quality of care at the forefront of clinical management.
Additional authors: Jennifer Frankel, MD (Emergency Medicine); Sara Boblick Smith, MD (Pediatric Medicine); Alexandra Bullough, MD (Anesthesiology)
Reference: “Interdisciplinary team training identifies discrepancies in institutional policies and practices,” American Journal of Obstetrics and Gynecology, 2011 Mar 30 [Epub ahead of print]
Funding: GME Innovations Grant from the University of Michigan Medical School Office of Graduate Medical Education