Critical birth drills help prepare staff

You probably conduct fire drills, evacuation drills, infant abduction drills, and mass casualty drills, but there is one more you might want to add to the schedule: critical birth drills to help obstetric staff prepare for the high-risk emergent birth with the potential for a tragic outcome and major liability.

Fairview Southdale Hospital in Edina, MN, routinely conducts critical birth drills. They have greatly increased the staff's confidence in responding to high risk birth scenarios, says David C. Seivert, CPCU, ARM, senior director of risk management services at parent company Fairview Health Services in Minneapolis. The drills are an especially effective risk management strategy since obstetrics represents such a large liability risk for most health providers, he says. The drills focus on the key element that can make the most difference in a critical birth: communication.

"Our claims history tells us that it's not necessarily the skill sets or lack thereof with our clinicians that are the big issue in these incidents," he says. "It's primarily the breakdowns in sharing critical information between members of the team that contribute to bad outcomes."

The first drill was in January, and there have been 10 so far at Fairview Southdale, which is piloting the program. Soon, Seivert expects to start the same drills at the organization's other hospitals. The experience at Southdale has proven the value of the drills, he says.

Realistic scenario for drill

The critical birth drills are made as realistic as possible by using a $30,000 doll that simulates a mother and newborn baby in distress, with cables running to a computer that can determine how the clinicians' actions would affect a real child, explains Stanley Davis, MD, an OB-GYN specialist in Minneapolis.

The "SimWoman and SimBaby" device is designed to test labor and delivery teams on every conceivable medical, biological, cultural, and logistical variable. The woman mannequin has a large belly containing a mannequin baby, and it even contains simulated bodily fluids and detailed anatomical features. The mannequin is a variation of the SimMan mannequin manufactured by Laerdal Medical Corp., a medical device manufacturer in Wappingers Falls, NY. (For more information, see the company's web site at www.laerdal.com.)

The drill uses a scenario that is realistic and creates a high-risk birth scenario. In a typical drill, a pregnant woman is in a car accident that leaves her bleeding internally. Her blood pressure is falling, and she goes into premature labor. To make things more difficult, the woman cannot speak English.

The woman, an actor, is rushed into an operating room for an emergency cesarean, which the mother initially refuses. Eventually the baby emerges blue and not breathing. The birthing team calls a Code Blue and begins to care for the dying baby. Davis uses a radio to talk with the lead physician through an earpiece, describing the scenario as it changes. He might radio the message, "The uterus has just ruptured," and the team must respond appropriately.

"The drill creates a stress dynamic so we can see where we might develop flaws in the process and team performance," he says. "We want to simulate a situation in which people are being pushed very hard so that we can see the weaknesses in our system."

Post-drill review is vital

Each of the critical birth drills is videotaped, and the post-drill review of that tape is a crucial part of the experience, Seivert says. The participants learn some lessons in the midst of the drill, but some of the most valuable information is gleaned from watching the tape and discussing it with other team members to identify where performance was lacking and how it might be improved.

"The debriefing is where all the gold is," Davis says. "That's where you have time to look at it from the outside in and see things you were too busy to think about at the time."

In addition to communication issues, the drills have revealed some practical ways to improve response during critical births, Seivert says. One drill revealed that the phone used to request blood during an emergency was not easily accessible to the anesthesiologist responsible for that request. If he or she could not leave the patient's side, the circulating nurse would be asked to go to the phone and request the blood. But there was at least one birth in which the request was not heard or the nurse was too busy, so the blood was not ordered. The phone was moved to a more convenient location so the anesthesiologist could request blood without leaving and without an intermediary.

The critical birth drills also led to a change in the way team leaders are identified during a critical birth. To facilitate better communication and leadership, physicians and certain other team members wear different colored scrub hats so that they are easily identified in a crowded, busy room.

"Some of the improvements are not that complicated, but the team members didn't even realize there was a problem to address until they went through the drill and analyzed it afterward," Seivert says.

Sources

For more information on critical birth drills, contact:

  • Stanley Davis, MD, OBGYN West, 800 Prairie Center Drive, Suite 130, Eden Prairie, MN 55344. Telephone: (952) 249-2000. E-mail: Sdavis5@fairview.org.
  • David C. Seivert, CPCU, ARM, Senior Director, Risk Management Services, Fairview Health Services, 2450 Riverside Ave., Minneapolis, MN 55454. Telephone: (612) 672-6956. E-mail: dseiver1@fairview.org.