377 - Implementation of Simulation Training to Reduce Perinatal Morbidity and Mortality: A Statewide Experience

Poster Number: 377
Publication Number: 377.434

Scott O. Guthrie, Monroe Carell Jr. Children's Hospital at Vanderbilt, Jackson, TN, United States; Patricia A. Scott, Tennessee Initiative for Perinatal Quality Care, Lebanon, TN, United States; brenda f. barker, TIPQC, Nashville, TN, United States; Theresa A. Scott, Vanderbilt University Medical Center, Nashville, TN, United States; Ashley Lerro, TIPQC, Jackson, TN, United States; Danielle Tate, UTHSC/UTROP, Memphis, TN, United States; Rolanda Lister, Vanderbilt University Medical Center, Nashville, TN, United States; Bonnie J. Miller, Regional One Health/TIPQC, Cordova, TN, United States; Mary Lee S. Lemley, MCJCH @ Vanderbilt, Springfield, TN, United States; Elizabeth A. Copenhaver, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Reagan M. Saig, Ascension St. Thomas Midtown, Nashville, TN, United States; Cornelia R. Graves, Tennessee Maternal Fetal Medicine/University of Tennessee, Nashville, TN, United States

Background: In 2020, the Joint Commission (JC) implemented new elements of performance for management of maternal hemorrhage and severe hypertension/preeclampsia. This included regular simulation drills to reduce maternal morbidity and mortality. Recognizing the opportunity to combine targeted training of the obstetrical and neonatal team, the Tennessee Initiative of Perinatal Quality Care (TIPQC) obtained grant funding to launch a statewide initiative targeting the participation of all 61 of the birthing facilities in TN.

Objective: The aim of this project was to form a state-wide joint obstetrical/neonatal simulation program to address common emergencies and build technical skills for all birthing facilities throughout Tennessee.

Design/Methods: Birthing facilities attended a six-hour workshop hosted by TIPQC in June 2021. Training included didactics on the benefits of simulation, JC standards, and debriefing after simulation. Simulation targeting specific maternal/neonatal skills was also undertaken and then combined maternal/neonatal simulations were performed around hypertension and hemorrhage. Centers received a simulation tool kit including a maternal and infant simulator, other equipment helpful to simulation training, and instructions on incorporation of simulation training locally.

Results: 89% (n=49) of TN birthing facilities sent educators to TIPQC’s training or received individual training after the event (n=5). 80% were level 1 or 2 and 20% were level 3 or 4. 83 of the 141 participants completed evaluations with 95% ranking the training as excellent and 99% stating increased confidence in the ability to incorporate simulation training into their facility. Post-training surveys are being sent quarterly to ascertain impact and 61% (n=30) of participating hospitals have responded. There has been a 27.6% increase in maternal simulation training (72.4% vs 100%) and 36.7% increase in neonatal simulation training (63.3% vs. 100%), p=0.03. Responding hospitals have reported a positive impact on clinical practice with 83.3% reporting moderate or major impact. 69%(n=20) reported real-life cases occurring following training with 75% (n=15) noting a moderate-major impact on assessment, 70% (n=14) a moderate-major impact on response/management, and 70% (n=14) a moderate-major impact on teamwork.Conclusion(s): By combining uniformed, evidence-based training with a modifiable approach to suit individual hospital needs, we are confident the implementation of a statewide simulation training program will aid in reducing perinatal morbidity and mortality in Tennessee.