Checklists and multidisciplinary team performance during simulated obstetric hemorrhage

Abstract

Background: Checklists can optimize team performance during medical crises. However, there has been limited examination of checklist use during obstetric crises. In this simulation study we exposed multidisciplinary teams to checklist training to evaluate checklist use and team performance during a severe postpartum hemorrhage.

Methods: Fourteen multidisciplinary teams participated in a postpartum hemorrhage simulation occurring after vaginal delivery. Before participating, each team received checklist training. The primary study outcome was whether each team used the checklist during the simulation. Secondary outcomes were the times taken to activate our institution-specific massive transfusion protocol and commence red blood cell transfusion, and whether a designated checklist reader was used.

Results: The majority of teams (12/14 (86%)) used the checklist. Red blood cell transfusion was administered by all teams. The median [IQR] times taken to activate the massive transfusion protocol and transfuse red blood cells were 5min 14s [3:23-6:43] and 14min 40s [12:56-17:28], respectively. A designated checklist reader was used by 7/12 (58%) teams that used the checklist. Among teams that used a checklist with versus without a designated reader, we observed no differences in the times to activate the massive transfusion protocol or to commence red blood cell transfusion (P>0.05).

Conclusions: Although checklist training was effective in promoting checklist use, multidisciplinary teams varied in their scope of checklist use during a postpartum hemorrhage simulation. Future studies are required to determine whether structured checklist training can result in more standardized checklist use during a postpartum hemorrhage.

Keywords: Checklist; Multidisciplinary; Obstetrics; Postpartum hemorrhage; Simulation.

Fig. 1

Postpartum hemorrhage checklist used during the drill. BP: blood pressure; HR: heart rate; Sats: oxygen saturation; RR: respiratory rate; PPH: postpartum hemorrhage; POC: products of conception; RSN: resource staff nurse; MTP: massive transfusion protocol; IV: intravenous; CBC: complete blood count; OR: operating room; D+C: dilation and curettage

Fig. 2

Checklist for initial management of postpartum hemorrhage (in current clinical use, at the time of manuscript preparation). PPH: postpartum hemorrhage; OB: obstetric; IV: intravenous; OR: operating room; IR: interventional radiology; TEG: thromboelastography; ABG: arterial blood gas; CBC: complete blood count; PT: prothrombin time; PTT: partial thromboplastin time; INR: international normalized ratio; Ca: calcium; QBL: quantification of blood loss; MTP: massive transfusion protocol; FFP: fresh frozen plasma