Validating Obstetric Emergency Checklists using Simulation: A Randomized Controlled Trial

Abstract

Background The World Health Organization's Surgical Safety Checklist has demonstrated significant reduction in surgical morbidity. The American Congress of Obstetricians and Gynecologists District II Safe Motherhood Initiative (SMI) safety bundles include eclampsia and postpartum hemorrhage (PPH) checklists.

Objective To determine whether use of the SMI checklists during simulated obstetric emergencies improved completion of critical actions and to elicit feedback to facilitate checklist revision.

Study Design During this randomized controlled trial, teams were assigned to use a checklist during one of two emergencies: eclampsia and PPH. Raters scored teams on critical step completion. Feedback was elicited through structured debriefing.

Results In total, 30 teams completed 60 scenarios. For eclampsia, trends toward higher completion were noted for blood pressure and airway management. For PPH, trends toward higher completion rates were noted for PPH stage assessment and fundal massage. Feedback resulted in substantial checklist revision. Participants were enthusiastic about using checklists in a clinical emergency.

Conclusion Despite trends toward higher rates of completion of critical tasks, teams using checklists did not approach 100% task completion. Teams were interested in the application of checklists and provided feedback necessary to substantially revise the checklists. Intensive implementation planning and training in use of the revised checklists will result in improved patient outcomes.

Keywords

checklist - eclampsia - maternal hemorrhage - safety - simulation

Condensation

Multidisciplinary teams completed more critical clinical steps and were enthusiastic about the use of crisis checklists during maternal hemorrhage and eclampsia simulations.

• References

• 1 van Klei WA, Hoff RG, van Aarnhem EE , et al. Effects of the introduction of the WHO “Surgical Safety Checklist” on in-hospital mortality: a cohort study. Ann Surg 2012; 255 (1) 44-49
• 2 Haugen AS, Søfteland E, Almeland SK , et al. Effect of the World Health Organization checklist on patient outcomes: a stepped wedge cluster randomized controlled trial. Ann Surg 2015; 261 (5) 821-828
• 3 Neily J, Mills PD, Young-Xu Y , et al. Association between implementation of a medical team training program and surgical mortality. JAMA 2010; 304 (15) 1693-1700
• 4 Haynes AB, Weiser TG, Berry WR , et al; Safe Surgery Saves Lives Study Group. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009; 360 (5) 491-499
• 5 Spector JM, Agrawal P, Kodkany B , et al. Improving quality of care for maternal and newborn health: prospective pilot study of the WHO safe childbirth checklist program. PLoS ONE 2012; 7 (5) e35151
• 6 Gawande A. The Checklist Manifesto: How to Get Things Right. New York, NY: Metropolitan Books; 2010
• 7 Haynes AB, Berry WR, Gawande AA. What do we know about the safe surgery checklist now?. Ann Surg 2015; 261 (5) 829-830
• 8 Arriaga AF, Bader AM, Wong JM , et al. Simulation-based trial of surgical-crisis checklists. N Engl J Med 2013; 368 (3) 246-253
• 9 ACOG. Safe Motherhood Initiative. Available at http://www.acog.org/About-ACOG/ACOG-Districts/District-II/Safe-Motherhood-Initiative
• 10 Glaser BG. The constant comparative method of qualitative analysis. Soc Probl 1965; 12: 436-445
• 11 Urbach DR, Govindarajan A, Saskin R, Wilton AS, Baxter NN. Introduction of surgical safety checklists in Ontario, Canada. N Engl J Med 2014; 370 (11) 1029-1038
• 12 Bliss LA, Ross-Richardson CB, Sanzari LJ , et al. Thirty-day outcomes support implementation of a surgical safety checklist. J Am Coll Surg 2012; 215 (6) 766-776