Can inter-professional simulation training influence the frequency of blood transfusions after birth?

Abstract

Objective: To investigate whether inter-professional simulation training influenced the rate of red blood cell (RBC) transfusions after birth.

Design: Two cohorts were compared retrospectively using a pre-post design.

Setting: Norwegian university hospital with 4800 deliveries annually.

Population: Women with estimated blood loss >500 mL within 24 h after birth in 2009 and 2011.

Methods: In 2010, all maternity staff attended a 6-h, scenario-based training on emergency obstetrics including postpartum hemorrhage, using a birthing simulator. The simulation focused on prevention, identification, and treatment of postpartum hemorrhage and on communication and leadership. Debrief immediately after the scenarios involved reflection and self-assessment.

Main outcome measures: The frequency of women receiving RBC transfusions as a marker for blood loss. Secondary outcome was the frequency of surgical procedures in the management of postpartum hemorrhage.

Results: In 2009, 111/534 (20.8%) women with estimated blood loss >500 mL after birth received RBC transfusions vs. 67/546 (12.3%) in 2011 (p < 0.01). The adjusted odds ratio for women receiving RBC transfusions in 2011 vs. 2009 was 0.53 (95% CI 0.38-0.74). Parity, oxytocin augmentation, duration of second stage, episiotomy, operative vaginal delivery, and sphincter injury were included in the final model. The odds ratio was stable in all combinations of possible confounders. We observed a significant reduction in the frequencies of curettage (p < 0.01) and uterine artery embolizations (p = 0.01).

Conclusion: We found a significant reduction in RBC transfusions after birth, which might be associated with mandatory simulation training. A causal link cannot be documented because of complex interactions of several variables.

Keywords: Post-partum hemorrhage; blood transfusion; morbidity; simulation training.