A New Direction In Simulation Education: Regionalizing Low Fidelity Obstetric Emergency Simulation Classes So All Hospitals Can Participate

Purpose for the program:   Simulation education is a complex subspecialty within nursing and medical education. Many hospitals have not been able to implement team training and clinical drills for a variety of reasons. One method for enhancing the uptake and implementation of simulation education is “regionalization”. In this model, a regional medical center provides customized low fidelity simulation classes that promote high quality, feasibility, and sustainability.

Proposed change:   The Joint Commission recommends that perinatal departments conduct team training, clinical drills, and debriefings as a maternal and neonatal death prevention strategy. This program provides obstetric simulation classes to affiliated hospitals and invites key stakeholders to observe the debriefings and witness the value of simulation education. This process creates buy-in to support the classes, resulting in sustainable and feasible change.

Implementation, outcomes and evaluation:   The regional simulation specialist collaborates with a department facilitator from the surrounding hospital. This collaborative process allows for the simulation training needs to be identified. Customized scenarios are then developed based on the learning needs of the hospital staff. Each simulation class has measurable objectives tailored to local needs.

The four hour class begins in a classroom with a thirty minute PowerPoint presentation that highlights simulation education and defines performance expectations for class participants. The participants are familiarized with the manikins, equipment, and props in the labor room. The simulation scenarios are videotaped and followed by formal confidential debriefings. During the debriefings, team performances are discussed and system issues are revealed. Areas of improvement are identified and written notes are taken for staff to work on at a later date. The participants sign a confidentiality agreement and photo consent. Lastly, a questionnaire is administered to the participants as an evaluation tool that measures their response to the simulation class.

Implications for nursing practice:   Most maternal deaths occur in an obstetric setting during an acute crisis. While maternal deaths are rare, it is estimated between 30 and 50 percent of these deaths may be prevented if perinatal teams improve their ability to recognize and respond to obstetric emergencies. Simulation provides an outstanding forum for practicing emergencies, perfecting roles, and identifying system issues. Observations during debriefings by key stakeholders promotes acceptance of the need for funding this training resource. A regionalized simulation program is an innovative, efficient means of providing specialized education for hospitals with limited educational resources.

Keywords:  simulation education, team training, low fidelity, in-situ, obstetric emergency, key stakeholders