Simulation training in Obstetric emergencies

Dr. Thomas Kou Associate consultant, O&G, QEH

7th May 2012

Meeting the challenges

Influx of mainland China expectant mothers -> overwhelm Obstetric, neonatology, ICU services, etc

HA decreased quota for non-entitled persons (NEP) since April 2011

Dramatic increase in non-booked labouring patients attending A&E at the last minute

Meeting the challenges

Meeting the challenges

Meeting the challenges

Pose an unique and important challenge to A&E department

Less familiar with delivery process

High risk of complications: No regular antenatal checkup In advanced labour Antenatal complications are not

managed properly eg. Big baby, growth restriction, gestational diabetes, etc.

How to meet the challenges?

Design

The solution is to provide simulation training

A multidisciplinary team

Obstetricians

Midwives

Paediatricians

A&E staff

Multi-Disciplinary Simulation and Skills Centre (MDSSC)

Design

Target:

Schedule

16th September 2011

9th December 2011

27th March 2012

Coming 3 more sessions

All A&E doctors and nurses

Design

Why simulation training? Low cost

High fidelity

Better engagement of trainees

Promising study results on obstetric simulation training

Venue: Multi-Disciplinary Simulation and Skills Centre of QEH

Design

Stations:

1. Managing a normal spontaneous delivery

2. Shoulder dystocia

3. Cord prolapse

4. Neonatal resuscitation

Design

Trainee manuals: pre-reading

Lectures (15 minutes on each topic)

Hand-on practices

Debriefing

Station 1: Normal spontaneous delivery

Station 2: Shoulder dystocia

Station 3: Cord prolapse

Station 4: Neonatal resuscitation

Evaluations

Total participants: 61

Doctors : 20 (33%) Nurses : 41 (67%) Return of evaluation forms : 59/61 (97%)

No. of doctors No. of Nurses Total

16th Sept 2011 8 13 21

9th Dec 2011 5 16 21

27th Mar 2012 7 12 19

Evaluations

Questions Yes No

1. The program was useful and informative 59/59 (100%) 0/59

2. The aims and objectives were clear 59/59 (100%) 0/59

3. Learning objective were achieved 59/59 (100%) 0/59

4. The learning-teaching activities were congruent which the overall program objectives and content

59/59 (100%) 0/59

5. The presenter/speaker/facilitator have demonstrated up-to-date professional knowledge and expertise

59/59 (100%) 0/59

6. The teaching method was appropriate 59/59 (100%) 0/59

7. The facility (e.g. venue) was appropriate 59/59 (100%) 0/59

8. The length of the program was: Too long About right Too short

0/59 56/59 (95%) 3/59 ( 5%)

Evaluations

Other comments:

Extend the workshop to full day session

Videos can be added

Add vaginal breech delivery/pre-eclampsia

Clinical attachment to labour room

Conclusions

Feedbacks from trainees and trainers are encouraging and reflect high satisfaction

The workshop will be run regularly to meet the demand and enhance A&E staff’s competency in managing obstetric emergencies

Future

? More NEP attending A&E in 2013 after quota becomes zero

Extend to A&E in other hospitals which are without obstetric support (8 HA hospitals)

More types of emergencies scenarios