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


Poster Presentation

Purpose for the Program

To coordinate the obstetric (OB) rapid response team with the emergency department trauma team of a busy community hospital. Attendance by OB and emergency staff at an Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) webinar, Perinatal Code Management, sparked a lively dialogue from which evolved a plan for simulation. A policy on management of the OB 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 newborn via emergency cesarean within the recommended 5 minutes after cardiac arrest? Because it could be applied to the emergency department, simulation often was used on the OB unit for staff training of critical situations.

Proposed Change

When the OB 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. The multidisciplinary team participants identified included members from the emergency department, labor and delivery, neonatal intensive care unit, and other ancillary departments. The following education items were identified for presimulation review: communication, team purposes, roles, and equipment. A scenario was developed for the simulation that incorporated a pregnant female who had been in a motor vehicle accident and was experiencing cardiac arrest after admission to the emergency room.

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 were 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/interspecialty coordination. Teams who normally function well in rapid response situations may react differently when taken out of familiar environments.

The OB 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 that require support by the OB rapid response team (e.g., stroke).