Collaboration and Simulation: Striving for Obstetric Excellence with the Emergency Department

Purpose for the program:

• The purpose was to coordinate the OB rapid response team with the emergency department trauma team of a busy community hospital.   Attendance by obstetric and emergency staff at an AWHONN webinar:  “Perinatal Code Management” sparked a lively dialogue from which evolved a plan for simulation.  A policy on management of the obstetric patient for the emergency department worked well in most situations. The focus was to fine-tune the actual response times and process.  How do we work together?  Is it possible to deliver a baby via emergency c-section within the recommended 5 minutes following cardiac arrest?  Simulation was often used on the obstetric unit for staff training on critical situations; we could bring it to the emergency department.

Proposed change:

• When the obstetric team responds to the emergency department in critical situations, coordination of both interdisciplinary teams is important for best patient outcomes and coordinated emergency response.  Training most often occurs at department levels; this “silo” training can lead to challenges between the teams.  

Implementation, outcomes and evaluation:

• Coordinators first met to identify:  Current process, team members, best practice and purpose of the simulation.  Multi-disciplinary team participants identified included members from:  Emergency Department, L&D, NICU, and other ancillary departments.  Education items were identified for pre-simulation review:  Communication, team purposes, roles and equipment.   A scenario was developed for the simulation incorporating a pregnant female experiencing cardiac arrest after admission to the emergency room post MVA.
• The debriefing after the simulations was used to identify elements that went well and opportunities for improvement.  Initial notification of the teams worked well, as did management of patient care.  Some opportunities identified included:  Access and use of equipment, wayfinding, critical times and communication.  As a result of these findings, projects were assigned to specific team members to eliminate gaps.  Subsequent simulations were planned to test these changes.

Implications for nursing practice:

• Two separate critical response teams working together bring differences in communication and processes that must be identified and understood by all participants to promote true interdisciplinary/ inter-specialty coordination.  Teams who normally function well in rapid response situations may react differently when taken out of familiar environments.
• The obstetric department staff was familiar with the process of unit simulations, however the emergency department primarily used simulation for large, emergency management drills. Crew Resource Management processes were used for communication and identification of roles.

• Additional simulations are planned using additional patient situations requiring support by the OB Rapid Response Team (i.e. stroke).

Keywords: Obstetric rapid response team; critical obstetric patient; simulation