In order to improve staff response times to emergent situations and encourage effective communication, our perinatal and neonatal intensive care units collaborated to create an ongoing process that would allow team members to practice real-life critical birth scenarios. Literature indicates that high-reliability perinatal units thrive on teamwork (Knox & Simpson, 1999). The creation and implementation of coordinated drills became a primary goal. Funds were not budgeted however, and team leaders had to explore creative solutions. Objectives included: review and define clinician roles, identify communication barriers that decreased response times, identify areas for improvement, implement drills, and evaluate outcomes.

Program Creativity

Financial resources were not available to buy simulators. Instead, the team decided to conduct drills on-site using scenarios written from actual patient cases that created a high-risk atmosphere. Four different emergencies were rehearsed giving clinicians the opportunity to use “real equipment” in their “real world” which proved invaluable according to their written feedback. Phase One, surprise drills, gave the nursing staff an opportunity to hone their skills and communication with one another. Phase Two drills were formally scheduled; they included physicians and debriefing sessions.

Major Program Outcomes

Modified Likert scales were used to measure feedback before and after the commencement of drills. The first survey demonstrated that 7-14% of the staff disagreed with statements such as “my coworkers know how to effectively respond in an emergency” and “I feel confident in what to do during an emergency.” Following Phase Two 100% of the respondents (96% return rate) agreed or strongly agreed with statements such as “I feel confident with the skills I need to perform in an emergency situation,” “I know my role/responsibilities in clinical emergencies,” and “I feel the clinical drills will benefit patient outcomes.”
In addition, stat cesarean sections had measurable decreased response times from 13-15 minutes from decision to incision to 11-12 minutes.
Sampling of other positive outcomes:
1.     Increased communication and respect between units and among clinicians
2.     Purchase of communication whiteboard
3.     Reorganization of OR equipment

Timeline

Ø      Goals and objectives defined Ø      Literature review/brainstorming Ø      Solicit team leaders, create scenarios, define code procedures Ø      Reconfigure communication system, define roles	2004 Fall-2004 Spring-2005 Fall-2005 Spring-2006 Fall-2006 Spring-2007 Fall-2007 Spring-2008
Ø      Initiate Phase One: educate staff, FAQs, survey
Ø      Pilot drills Ø      Commence ‘surprise’ drills, collect data, review lessons learned Ø      Initiate Phase Two: Plan for scheduled drills Ø      Commence scheduled drills, collect data, measure outcomes

Relevance-Implications
A recent Institute of Medicine report calls for designing interventions with the objective of improving quality (Greiner & Knebel, 2004). The process that was implemented at this organization can be integrated in other hospitals and it demonstrates that money does not always need to be available to drive quality care. The heart of nursing is providing excellent care to every patient---the science of nursing is implementing evidence-based practice. In alignment with AWHONN’s 2009 goals to translate science into practice the critical birth drills had measurable positive outcomes, helped with unit team building, enhanced communication, and fostered staff confidence.