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Effect of in situ simulation training for emergency caesarean section on maternal and infant outcomes | BMC Medical Education | #childsafety | #kids | #chldern | #parents | #schoolsafey


Clinical data

Our facility consists of two hospital districts located in different parts of the urban area, specifically referred to as our headquarters and western districts. The two districts exhibit similarities in terms of their size, facilities, and staffing. Since August 2020, regular in-situ simulation training for emergency cesarean section has been conducted for the obstetric Rapid Response Team (RRT) in our headquarters, whereas such training has not been organized in western districts. The training group consisted of emergency cesarean sections performed in the delivery room of our headquarters, while the non-training group comprised emergency cesarean sections performed in the delivery room of the western districts. According to guidelines established by our institutional system, indications for initiating an emergency cesarean section in the delivery room include umbilical cord prolapse, severe fetal distress, uterine rupture, placenta previa bleeding, amniotic fluid embolism, and other acute and critical situations that pose an imminent threat to the well-being of the mother and child. Prolonged deceleration lasting more than 5 min was defined as severe fetal distress [10]. The 24-h-duty staff in the delivery rooms of the two hospital areas included two first-line doctors, one general obstetric resident, one anaesthetist, one anaesthetic nurse, and one midwife (6–10). Paediatricians and second- and third-line physicians were on duty for 24 h in the hospital. In situ simulation training for emergency caesarean section on RRT for obstetrics in our hospital district has been organised regularly since August 2020. All cases in which ECs were implemented in the operating room of the delivery room of two hospitals from September 2020 to August 2022 were collected, resulting in a total of 47 cases, including 19 cases in the untrained group of the western hospital and 26 cases in the training group of our hospital area. Considering that the effect of training may not immediately affect clinical outcomes, 2 cases in the month of training initiation (August 2020) were not included in the study.

In situ simulation training process

Upfront preparation

The medical office coordinated and established a simulation exercise team, and the director of the birthing center acted as the leader. Lectures were organised before simulation training to introduce knowledge related to emergency caesarean section procedures and in situ simulation training, including the delivery room environment, indications for emergency caesarean section procedures, and surgical process considerations. Training rounds occur semiannually. Each round lasted 4 weeks, began at 4 pm three weeks into the training period, and was completed by 3 sets of personnel each time. Training set: delivery room. Participating trainers: obstetricians, midwives, anaesthesiologists, and neonatologists of all shifts, divided into 12 groups, each containing one second-line physician (repeated grouping by ten attending and above physicians), one total obstetric stay (repeated grouping by two attending and above physicians), two residents, three midwives, one anaesthesiologist (repeated grouping by ten anaesthesiologists), one anaesthesia nurse (two anaesthesia nurses repeated grouping) and one neonatologist (four paediatricians repeated grouping). Attend to the individual roles and tasks of the personnel. All enrollees were required to participate in at least one in situ simulation training session. The team leader commanded and timed and third-line physicians (four obstetric ward directors) observed and hosted posttraining discussions and comments.

Implementation process

A prolapsed cord was used as the subject for the scenario. A high-fidelity simulation was accomplished using a mannequin with a fetus and varying fetal heart tones to mimic a prolapsed cord. The first responder was the midwife, who noted the cord prolapse. The actual alarm bells on the unit were used to alert the other participants. Obstetricians, anesthetists, and pediatricians all responded, took on their usual roles, and performed their respective tasks. This included applying pressure on the fetal head, communicating with the family, initiating general anesthesia, beginning surgery, and resuscitation of the newborn.

Postsimulation site evaluation and discussion

After on-site evaluation and discussion after simulation, the team members fill in the satisfaction questionnaire on site. The satisfaction questionnaire was designed and prepared by ourselves in combination with the actual situation of the hospital after consulting the literature [11], and the content put forward 6 questions centering on the simulated training: Whether the training objectives are clear; Whether the training scenarios are related to clinical practice; whether the established learning objectives have been achieved; Whether the knowledge gained from this training can influence their clinical practice; Whether this training has enhanced their confidence in treating patients in crisis; Whether this training has given you more new knowledge and skills. Participants were asked how much they agreed with this question using a 5-point Likert scale (strongly agree, agree, fair, disagree, strongly disagree). After the completion of the questionnaire collection, on-site discussion was conducted. First, team members made self-evaluation and reflected on their own and team performance. Then, third-line doctors made comments, including the operation completion degree, cooperation degree and DDI of each member. Finally, the improvement contents were proposed.

Outcome measures

Primary outcomes: DDI; Secondary outcomes: trainees’ satisfaction with the training, demographics of both groups, decision to incision interval, incision to fetal delivery interval, indications for cesarean section, operation time, intraoperative bleeding, neonatal birth weight, 1 min Apgar score, 5 min Apgar score and length of patient stay.

Statistical methods

The data were statistically analysed by IBM SPSS 23.0 software, and the data were measured as mean ± standard deviation. Normally distributed data were compared by t test, and nonnormally distributed data were compared by rank sum test. Count data were compared with χ2 or Fisher’s exact test. P < 0.05 was considered statistically significant.

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