How to conduct critical birth drills

This advice for conducting critical birth drills comes from Stanley Davis, MD, an OB-GYN specialist at Fairview Health Services in Minneapolis:

  • Realize that a critical birth drill is difficult to organize. Davis compares it to making a movie. You have to get a lot of people together in one place at one time, when most of them have other demands on their time. You have to set up a lot of equipment first, and you have to have a script that key people know ahead of time.
  • The drills cannot be a surprise. Though it would be ideal to conduct the drills without warning, the way real high-risk births happen, it just isn't practical in most hospitals. Organizing the participants and choosing a time when all the key members can be there is difficult enough without trying to spring the drill on people without warning.
  • Encourage team members to react in realistic ways. Brief the participants about the basics of how the drill will be run, such as the simulated baby and how it works. Then encourage them to take the drill very seriously and respond just as they would in true crisis.

Point out to the participants that the purpose of the drill is not to judge their individual skills and find cause for disciplinary action. Rather, the purpose is to improve team dynamics and the system for responding to critical births.

  • Alert ancillary departments to the drill. For instance, you should let the blood bank know that the team may call to request blood. If they do, the bank should be prepared to send empty blood bags (with proper labels and coding, so you can check that part of the process) in the same manner it would deliver real blood.

The unexpected involvement of other departments can be revealing. In one Fairview drill, the physician called the main operating room for a pigtail catheter to use in an emergency hysterectomy, and the drill revealed a breakdown in communication. The nurses in the main OR were not sure exactly what he was requesting, and the two parties did not adequately converse to try to figure out what was needed for the emergency.

  • Try to conduct the drills at different times of day to involve staff from different shifts. This step also can be a difficult part of scheduling a drill. At his hospital, most of the drills are conducted from 6 p.m. to 10 p.m. because that is the only time the anesthesiologists are free. Three of the drills were conducted from noon to 4 p.m. As much as possible, rotate staff from different shifts through the drills.
  • Always videotape the drill. It's not enough to discuss the drill afterward without a videotape to watch. A critical birth drill should be high stress and fast paced, so it isn't possible for people to recognize and remember all the critical details.
  • Administration should respond quickly and visibly to the team findings. When the drill revealed that the clinicians needed a phone at the patient's bed side, the hospital had the phone installed within a week. Davis says that signaled to the team that the drills were important to administration and their findings would be acted on quickly.