The Effectiveness of Teaching Shoulder Dystocia Management Using Simulation [2]

Marko, Emily; Buery-Joyner, Samantha D.; McLeod, Francine; Sheridan, Michael J.; Coleman, Craig R.; Nieves, Kelsey

doi:10.1097/01.aog.0000463521.28030.95

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“…Given the rarity of shoulder dystocia, teams have turned to simulation drills to improve preparedness and outcomes. Although research has shown that simulation improves clinical outcomes, communication, and the use of obstetrical maneuvers, 5,6 obstetrical providers often document shoulder dystocia cases in a suboptimal fashion. 7 When a patient presents in a subsequent pregnancy with a history of a shoulder dystocia, the documentation regarding the delivery events is key when counseling regarding the recommended route of delivery.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of multidisciplinary shoulder dystocia simulation training on knowledge, performance, and documentation

Olson

Logan

Gibson

2021

American Journal of Obstetrics & Gynecology MFM

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BACKGROUND: Research has shown the utility of simulations involving individuals, yet little data exist on whether communication and documentation are impacted by the integration of all team members into a scenario. In 2018, the obstetrics department at this tertiary hospital began a multidisciplinary team-training simulation for shoulder dystocia. An educational portion was included, teaching a new practice where the provider announces delivery events (head, shoulder, body) to be marked on the delivery record, a standardized approach was introduced, and a pre-and post-simulation test was administered. OBJECTIVE: In this study, we sought to evaluate the lasting impact of this team-based tool on the outcomes and documentation of shoulder dystocia cases, specifically the recording of the exact shoulder dystocia duration in seconds. Secondary outcomes included evaluation of the documentation of shoulder dystocia maneuvers and a pre-and post-simulation knowledge test. Included in this test were questions from the validated survey, the Safety Attitudes Questionnaire, a tool focused on evaluating team dynamics and communication. It was hypothesized that this simulation would improve communication as shown by sustained improvement in documentation, competence in shoulder dystocia care, and confidence among members of the team as shown by improved scores on the Safety Attitudes Questionnaire. STUDY DESIGN: This was a retrospective cohort study of shoulder dystocia cases from 2017 and 2019 at a safety-net tertiary care hospital, 1 full year before and after the implementation of a multidisciplinary shoulder dystocia simulation in 2018. Delivery outcomes were compared, documentation of delivery event times was recorded and analyzed, and the delivery note was evaluated using the American College of Obstetricians and Gynecologists guidelines for shoulder dystocia. The surveys from participants were assessed for postsimulation improvement.Categorical variables were analyzed using chi-square tests and continuous variables were compared using Student t tests. Because shoulder dystocia duration is a nonparametric variable, this was compared using a Kruskal-Wallis test. RESULTS: There were 28 cases in the 2017 cohort and 25 in the 2019 cohort. In the 2017 cohort, 25% of delivery documentation (7 of 25) included the exact shoulder dystocia duration, which increased to 96% (24 of 25) in the 2019 cohort (P<.001). There was no significant impact on the shoulder dystocia duration (P=.163). On average, 2.7 maneuvers were required in the 2017 cohort, which increased to 3.4 maneuvers used in the 2019 cohort, showing a significant increase in the use of shoulder dystocia maneuvers (P=.030). The posttests showed no impact on shoulder dystocia background knowledge (P=.142) or knowledge of risk factors (P=.171) but did show an increased understanding of the definition and performance of shoulder dystocia maneuvers (P=.008). The Safety Attitudes Questionnaire revealed that simulation participants would feel safe being treated by their colleagu...

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Section: Introductionmentioning

confidence: 99%