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 5 min 14 s [3:23–6:43] and 14 min 40 s [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.

Factors associated with the use of cognitive aids in operating room crises: a cross-sectional study of US hospitals and ambulatory surgical centers

“…Training is essential for clinicians to gain familiarity and to use the aids effectively. Research shows that clinicians and teams are more likely to utilize OR cognitive aids when they are trained in their use [ 46 – 48 ]. Without sufficient training, providers may put the cognitive aids aside or even misuse them by using the wrong checklist or algorithm [ 2 ].…”

Development of the TeamOBS‐PPH – targeting clinical performance in postpartum hemorrhage

“…summative evaluation of performance. It is not designed to be used as an alternative for a procedural checklists or as a cognitive aid for teams to follow during the event .…”

“…Tools for clinical performance assessment are very detailed, as each required action has a weighted score reflecting its importance and the timing of actions involved . Thus, these tools differ from procedural checklists that are used during management of PPH to help the team to remember elements specified in local guidelines . Clinical performance tools are very useful for feedback and formal debriefing of the team .…”

Barriers to collaborative anesthetic care between anesthesiologists and nurses on the labour and delivery unit: a study using a modified Delphi technique

“…25 Furthermore, checklists are being used to enhance teamwork during obstetrical emergencies. 26 The use of checklists not only standardizes critical clinical management steps, it also forces a shared mental model among team members, thereby enhancing crisis resource skills such as effective communication, role clarity, and anticipation of next steps. Finally, results from our study have called for more interprofessional teaching sessions, general education, and joint rounds.…”