1. Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide Prevention of PPH requires early recognition and intervention, as well as coordinated teamwork Simulation-based team training (SBTT) is a powerful tool for improving the functioning of inter-professional teams Recent research has begun to focus on the role of team training and the use of protocols in combating the impact of PPH A robust link between SBTT and clinical outcomes has not been demonstrated Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide Prevention of PPH requires early recognition and intervention, as well as coordinated teamwork Simulation-based team training (SBTT) is a powerful tool for improving the functioning of inter-professional teams Recent research has begun to focus on the role of team training and the use of protocols in combating the impact of PPH A robust link between SBTT and clinical outcomes has not been demonstrated BACKGROUNDRESULTS Simulation-Based Team Training Associated with a Reduction in Incidence of Severe Postpartum Hemorrhage Spencer McClelland, MD; Abigail Ford Winkel, MD; Jerome Lax, MD; Jean-Marie Nacer, MSN, RN; Sulema Roman, RN; Veronica Lerner, MD, FACOG NYU Langone Medical Center, New York, NY SBTT remains a powerful tool for education, team-building, and skill refinement SBTT may improve rates of severe hemorrhage in the obstetric setting Further research should be undertaken on the contribution of SBTT to key clinical questions Special focus should be placed on Level 3 data demonstrating improvement in clinical outcomes as a function of SBTT and related programs SBTT remains a powerful tool for education, team-building, and skill refinement SBTT may improve rates of severe hemorrhage in the obstetric setting Further research should be undertaken on the contribution of SBTT to key clinical questions Special focus should be placed on Level 3 data demonstrating improvement in clinical outcomes as a function of SBTT and related programs CONCLUSIONS AND IMPLICATIONS 1. 1.California Maternal Quality Care Collaborative (CMQCC) Obstetric Hemorrhage Toolkit: Hospital Level Implementation Guide. 2. 2.Markova V, Sørensen JL, Holm C, Nørgaard A, Langhoff-Roos J. Evaluation of multi-professional obstetric skills training for postpartum hemorrhage. Acta Obstet Gynecol Scand 2012; 91:346– 352. 3. 3.Vadnais MA et al. Assessment of long-term knowledge retention following single- day simulation training for uncommon but critical obstetrical events. J Matern Fetal Neonatal Med. 2012 September ; 25(9): 1640–1645. 4. 4.Toledo P, McCarthy RJ, Burke CA, et al. The effect of live and web- based education on the accuracy of blood-loss estimation in simulated obstetric scenarios. Am J Obstet Gynecol 2010;202:400.e1- 5. 5. 5.Wagner B, et al. Comprehensive Perinatal Safety Initiative to Reduce Adverse Obstetric Events. Journal for Healthcare Quality. Vol. 34, No. 1, pp. 6–15 6. 6.Merien AER, et al. Multidisciplinary Team Training in a Simulation Setting for Acute Obstetric Emergencies. Obstet Gynecol 2010;115:1021–31. 7. 7.ACOG Practice Bulletin No. 76. Postpartum Hemorrhage. 1. 1.California Maternal Quality Care Collaborative (CMQCC) Obstetric Hemorrhage Toolkit: Hospital Level Implementation Guide. 2. 2.Markova V, Sørensen JL, Holm C, Nørgaard A, Langhoff-Roos J. Evaluation of multi-professional obstetric skills training for postpartum hemorrhage. Acta Obstet Gynecol Scand 2012; 91:346– 352. 3. 3.Vadnais MA et al. Assessment of long-term knowledge retention following single- day simulation training for uncommon but critical obstetrical events. J Matern Fetal Neonatal Med. 2012 September ; 25(9): 1640–1645. 4. 4.Toledo P, McCarthy RJ, Burke CA, et al. The effect of live and web- based education on the accuracy of blood-loss estimation in simulated obstetric scenarios. Am J Obstet Gynecol 2010;202:400.e1- 5. 5. 5.Wagner B, et al. Comprehensive Perinatal Safety Initiative to Reduce Adverse Obstetric Events. Journal for Healthcare Quality. Vol. 34, No. 1, pp. 6–15 6. 6.Merien AER, et al. Multidisciplinary Team Training in a Simulation Setting for Acute Obstetric Emergencies. Obstet Gynecol 2010;115:1021–31. 7. 7.ACOG Practice Bulletin No. 76. Postpartum Hemorrhage. REFERENCES To assess the impact of a comprehensive SBTT program on PPH clinical outcomes OBJECTIVEMETHODS Simulation-Based Team Training All labor and delivery staff trained from March, 2012 to August, 2013 Two-hour, case-based in-situ simulations Inter-professional groups: OB attendings, residents, and mid-level providers; anesthesia attendings and residents; nurses; blood bank personnel and other ancillary staff Training Quantifying Blood Loss in place of Estimated Blood Loss Use of graduated under-buttocks drapes Weighing of dry materials (sponges, lap pads, towels) Assessment of Impact on PPH Incidence of PPH was calculated by chart review for the quarters surrounding the initiation of the SBTT program Definition of PPH: Definition of Severe PPH: EBL >500 mL for vaginal deliveryEBL >1500 mL EBL >1000 mL for Cesarean Transfusion >2u PRBCs Vital sign instability 50 OB/GYN providers, 56 nurses, and 67 Anesthesiologists participated in SBTT 25 cases of PPH were identified in the third quarter of 2012 (80% severe hemorrhage) 35 cases of PPH were identified in the first two quarters of 2013 (47% severe hemorrhage) 41% decrease in the rate of severe hemorrhage