Massive Hemorrhage Protocol Application and Teamwork Skills

Géraldine Pettersen; France Gauvin; Nancy Robitaille; Andrée Sansregret; Sandra Lesage; Arielle Levy

doi:10.1002/aet2.10513

Massive Hemorrhage Protocol Application and Teamwork Skills

AEM Educ Train. 2020 Aug 24;5(3):e10513. doi: 10.1002/aet2.10513. eCollection 2021 Jul.

Authors

Géraldine Pettersen¹, France Gauvin¹, Nancy Robitaille², Andrée Sansregret³, Sandra Lesage⁴, Arielle Levy⁵

Affiliations

¹ Critical Care Division Department of Pediatrics University of Montreal Montreal QC Canada.
² Hematology-Oncology Division University of Montreal Montreal QC Canada.
³ Department of Obstetrics-Gynecology University of Montreal Montreal QC Canada.
⁴ Department of Anesthesiology University of Montreal Montreal QC Canada.
⁵ Department of Pediatric Emergency Medicine University of Montreal Montreal QC Canada.

Abstract

Objective: Massive hemorrhages (MHs) are rare but serious complications of pediatric trauma and obstetric cases. This study aimed to evaluate the impact of interprofessional simulation to improve adherence to a MH protocol (MHP), teamwork skills and confidence levels during a hemorrhagic crisis situation.Methods: This was a pre-post experimental study conducted at a tertiary care mother-child simulation center. Pediatric emergency and obstetric teams were submitted to simulated trauma and postpartum MH scenarios. Training consisted of two case scenarios followed by debriefing sessions and a lecture on the MHP. The primary outcome was adherence to MHP processes (checklist) measured prior to and 2 weeks following training sessions. Other outcomes were the measure of teamwork skills (Mayo High Performance Teamwork Scale) and confidence of the participants.

Results: Sixty-two health care professionals were involved in eight interprofessional teams. Mean scores for adherence to the MHP improved from 19.1 in the pretraining phase to 25.8 in the posttraining phase (difference of 6.7; 95% confidence interval [CI] = 4.4 to 8.9). Mean scores pertaining to teamwork skills also improved significantly between pre- and posttraining phases (difference = 3.9; 95% CI = 1.5 to 6.4). Confidence questionnaires showed significant improvements in the posttraining phase (difference = 6.9; 95% CI = 5.3 to 8.3).

Conclusions: Targeted training involving simulation and protocol review improved participant adherence to MHP processes and teamwork skills. Confidence levels improved across all disciplines.