York Hospital / WellSpan Health, York, PA
Improving Obstetrical Rapid Response Teams (Code Neon): Multidisciplinary Simulation Training Using the Plan-Do-Study-Act Cycle

Abstract

Background: Citing a rise in maternal mortality and mrbidity, the American College of Obstetricians and Gynecologists (ACOG) and The Joint Commission (TJC) called for creation of obstetrical rapid response teams (RRT). Our objective was to create a multidisciplinary RRT via implementation of a mass page alert system; improve access to medication, equipment, and supplies; improve teamwork and communication during emergencies; improve staff satisfaction with emergency response; and identify the most common errors in OB emergencies.

Methods: The RRT commits to 4 half-day simulations annually. Each multidisciplinary training session includes a performance-improvement lecture for nurses and residents, a lecture in 1 emergency, small-group discussion using PDSA to consider trial changes for simulation, and group trial of PDSA changes during simulation. The in situ simulation is witnessed by the full team, videotaped, and added to the PDSA library. The team debriefs and creates an action plan; the PDSA changes are trialed clinically during real calls. Successful changes are implemented and reviewed at the next simulation.

Results: The team reduced the number of emergency response calls from 10 individual calls to one hospitalwide Code Neon Alert and reduced access to emergency medications from 12 steps to 2. A preintervention survey found that up to 30% of obstetrical providers perceived a deficit in teamwork and communication, and 40% perceived a deficit in access to equipment and supplies during emergencies. In a 2012 postsimulation survey, 98% of participants responded positively to a statement regarding the speed of staff emergency response, 75% responded positively regarding clear emergency communication, and 84% responded positively regarding the availability of emergency supplies and medications.

Conclusions: Multidisciplinary PDSA cycle training and simulation helped the RRT identify process and system barriers and encouraged team building and problem solving. PDSA simulation training empowers staff to implement clinical changes and improves patient care. Lack of obstetric EHRs impedes data collection needed for pre and post comparison.