Development and implementation of a team-centered shoulder dystocia protocol

Abstract

Objective: To develop and evaluate a team-centered shoulder dystocia protocol.

Methods: This project was undertaken in two phases. The first phase consisted of protocol development, during which a basic protocol was initially developed on the basis of targeted interviews with obstetric care providers and then refined through iterative performances of the protocol. The second phase consisted of dissemination of the final protocol to obstetric providers using low-fidelity simulation. Quantitative analysis was performed regarding the frequency with which key protocol components were undertaken during the unit-wide simulation drills.

Results: Qualitative data analysis revealed several potential impediments to optimal team function during a shoulder dystocia, including lack of understanding that a shoulder dystocia was occurring, difficulty with efficient summoning of additional staff, lack of role clarity, reduced situational awareness, and variable documentation. A protocol that seeks to overcome these impediments can be successfully introduced to obstetric personnel through simulated shoulder dystocia drills, during which providers become increasingly more likely to incorporate different actions of the protocol during a simulated shoulder dystocia.

Conclusions: Low-fidelity simulations can be used to introduce and improve the aspects of teamwork that may be useful for the management of shoulder dystocia.