Accuracy in blood loss estimation has been shown to improve immediately after didactic training. The objective of this study was to evaluate retention of blood loss estimation skills 9 months after a didactic web-based training.
Forty-four participants were recruited from a cohort that had undergone web-based training and testing in blood loss estimation. The web-based posttraining test, consisting of pictures of simulated blood loss, was repeated 9 months after the initial training and testing. The primary outcome was the difference in accuracy of estimated blood loss (percent error) at 9 months compared with immediately posttraining.
At the 9-month follow-up, the median error in estimation worsened to -34.6%. Although better than the pretraining error of -47.8% (P = 0.003), the 9-month error was significantly less accurate than the immediate posttraining error of -13.5% (P = 0.01).
Decay in blood loss estimation skills occurs by 9 months after didactic training.
[Show abstract][Hide abstract] ABSTRACT: The use of simulation in medicine has grown significantly over the past 2 decades. Simulation in obstetric anesthesia can be divided into four broad uses: technical skills, nontechnical or teamwork skills, individual clinical competence, and the safety of the clinical environment. This review will describe recent trends in the use of simulation in several of these categories.
Simulation continues to be an important part of skills (technical and cognitive) and teamwork training in obstetric anesthesia. The acquisition of simple and complex technical skills appears to be improved with the use of simulation. However, the assessment of these skills is currently done in the simulated environment. Simulation is also important in assessing and enhancing the safety of a labor unit. Two simulation trends have recently evolved. Instructional articles describing how to best perform simulation have begun to appear. In addition, several review articles have been published that demonstrate the maturation of the body of research in this field.
As the use of simulation continues to grow, research should concentrate on whether anesthesia or teamwork skills learned in the simulated environment change behavior and improve outcomes in the clinical setting. More instructional publications would also facilitate the growth into more clinical environments.
Current opinion in anaesthesiology 04/2012; 25(3):271-6. DOI:10.1097/ACO.0b013e3283531fdf · 1.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A culture of safety is a growing movement in obstetrical healthcare quality and management. Patient-centered and safe care is a primary priority for all healthcare workers, with communication and teamwork central to achieving optimal maternal health outcomes. A mandatory educational program was developed and implemented by physicians and nurses to sustain awareness and compliance to current protocols within a large university-based hospital. A didactic portion reviewing shoulder dystocia, operative vaginal delivery, obstetric hemorrhage, and fetal monitoring escalation was combined with a simulation session. The simulation was a fetal bradycardia activating the decision to perform an operative vaginal delivery complicated by a shoulder dystocia. More than 370 members of the healthcare team participated including obstetricians, midwives, the anesthesia team, and nurses. Success of the program was measured by an evaluation tool and comparing results from a prior safety questionnaire. Ninety-seven percent rated the program as excellent, and the response to a question on perception of overall grade on patient safety measured by the Agency for Healthcare Research and Quality safety survey demonstrated a significant improvement in the score (P = .003) following the program.
The Journal of perinatal & neonatal nursing 04/2013; 27(2):113-23. DOI:10.1097/JPN.0b013e31828cbb2a · 1.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Visual estimation of blood loss is often inaccurate and imprecise. Obstetric bleeding requires expedient identification and intervention to prevent maternal morbidity and mortality. We aimed to create a visual aid to improve accuracy of estimated obstetric blood loss.
We designed a pocket card containing images of blood on common obstetric materials to serve as a visual aid. We created six stations with known volumes of artificial blood using materials from standard delivery kits. Obstetric providers recorded visually estimated blood loss across a variety of volumes and materials before and after receiving our visual aid. We assessed the effects of blood volume, clinical role, and years of experience on accuracy of estimation.
One hundred fifty-one participants assessed six stations. We categorized participants by percent error of estimated blood loss before and after receiving our visual aid. We found a significant improvement in accurate assessments for all provider types after intervention across four of the six volumes (P<.001). In a posttest survey, 90% of participants (n=136) reported subjective improvement in estimation ability. Provider type affected accuracy before intervention in two of six stations (P=.01 and P=.03). This difference persisted in one station after intervention (P<.01). Years of experience did not correlate with accuracy of blood volume estimation in five of six stations (P>.05).
A visual aid depicting known volumes of blood on obstetric materials can improve accuracy of blood volume estimation among obstetric providers of varying types and with varying years of experience. LEVEL OF EVIDENCE:: II.
Obstetrics and Gynecology 05/2014; 123(5):982-986. DOI:10.1097/AOG.0000000000000233 · 5.18 Impact Factor
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