Transcription:

Deborah Howell (Host): Welcome. We all know that military and civilian pilots do a lot of training via simulation exercises. But what about healthcare providers? My guest today is Dr. Barton Staat, a Doctor of Maternal Fetal Medicine here at Deaconess, and recently retired as a Colonel in the Air Force. He'll be filling us in on simulation education at The Women's Hospital. Welcome Dr. Staat.

Barton Staat, MD, FACOG, Col. (Retired), USAF, MC (Guest): Thank you.

Host: Let's talk about simulation at The Women's Hospital in general to kick off.

Dr. Staat: What is simulation in obstetrics? Simulation in obstetrics revolves around doing procedures that either we don't see very frequently. So, maybe a condition or an emergency that is rare in nature. So something that we don't have opportunities to perform on a routine basis or simulation may revolve around a common condition that has multiple treatment pathways or the need to do multiple tasks and communication. And where we need to practice things that maybe we do see more frequently, but involve a lot of different healthcare providers or treatment pathways, things that are a little more complex.

Host: Sure. Let's get a little bit more specific. What is simulation in obstetrics?

Dr. Staat: So with obstetric simulation, there's some that we basically do at the hospital. And there's some that we plan to do at outreach hospitals. So some hospitals that were partners with through the Perinatal Center we go and try to support simulation in their units. But here at The Women's Hospital, we, we do practice so that when we have the opportunity to care for the mother who's experiencing a complication or an emergency that that we're not practicing on her, but performing to provide optimal outcomes.

Host: Sure makes perfect sense. And why do you think simulation is so important?

Dr. Staat: Well, so if it's something that's rare, say a condition called shoulder dystocia where the baby's head delivers, but the body and the shoulders do not; in those situations that can make the difference between a good outcome or a baby that, that needs NICU care or even has lifetime complications from the shoulder dystocia.

So it's so important that when seconds matter, that your team has been trained and is up to date. And also that they've functioned in times of an emergency that they know what they're doing/been able to practice emergency scenarios outside of an actual patient. One way to think about it would be pilots do a lot of simulations. And the first time that there was an emergency on the airplane, say there's an engine fire. You'd like them to have experienced this in a simulator and gone through their checklists and gone through their evasive actions or emergency procedures in a machine where the stakes aren't so high versus in real life where it could result in catastrophe.

And that's similar in medicine that we want to be able to practice when the stakes aren't high so that when the stakes are high and it's your baby that we're having to treat, that it's not our first time in a year or two, but something that we've been able to train on and practice more recently than the day of the emergency.

Host: Sure. And who should be participating in a simulation?

Dr. Staat: So with simulation, there's some scenarios that are kind of procedure heavy, like the shoulder dystocia where the providing deliverer, the obstetrician or midwife needs to be the one doing a lot of the drills. But even in that scenario, there's still teamwork needed and coordination needed. So, who should be participating is whoever's going to be there delivering the care.

So it's vital to have the obstetrician or midwife, but you still need a lot of the nursing leadership, the patient care nurse, as well as the tech and anesthesia and the pediatrician or the neonatal team to be all engaged and involved so that when there is an emergency, it's not just one person who knows what they're doing, but the whole unit and the whole team.

Host: Yeah, team approach. Now you spoke about the shoulder dystocia scenario. What other types of scenarios are used in simulations?

Dr. Staat: So the simulations I use shoulder dystocia as an example because it's something that that we don't see very frequent, but we have to respond urgently. One of the more common scenarios that we do see frequently would be a hemorrhage or postpartum bleeding after the baby's born. We use that as a simulation because it does require a lot of coordination. So with that, we're working with anesthesia, we're working with nursing, we're working with the lab and the blood bank and the pharmacy. So, it involves multiple areas of the hospital system. And it's one thing to have a response from say, the delivering provider, but you need to all be on the same kind of mental model or same page on how to deal with this emergency.

So you really need everybody involved that's gonna participate in the emergency. So hemorrhage is one. Another scenario that's less commonly seen, but can be life-threatening and an emergency would be eclampsia where the mother's having a seizure. Another scenario that is commonly done would be a breech delivery.

So, 40 or 50 years ago, breech deliveries commonly occurred and all the teams we're able to manage those. More frequently, we don't routinely deliver a lot of babies in a breech presentation or, butt first, so that's a scenario that we do practice because it's something, again, we don't routinely see. So those are some of the more commonly practiced or runs scenarios.

Host: And how in your opinion does simulation improve care?

Dr. Staat: So in terms of simulation, there has been lots of evidence supporting the role of simulation. Probably the most commonly supported in the medical literature would be with the shoulder dystocia that I mentioned earlier, they actually showed kind of decreased neonatal injury or trauma and NICU admissions for teams that have done simulation training recently, in a shoulder dystocia versus those that had not. So, it's something that you want to be able to provide the best care for your patients. And you also want to, if you're the patient, you want to know that the team taking care of you is kind of working as a team, up to speed on communication as well as emergencies.

And so that's probably the best use of evidence is with shoulder dystocia, but there's more and more evidence that working as, practicing helps you perform both in dystocia, but other emergencies, like I mentioned, with the postpartum hemorrhage.

Host: Right. And this is kind of a different question, but why should our patients care if their hospital does simulation?

Dr. Staat: It's something that they should care about because again, they hopefully we want everybody to come and deliver and have a nice smooth delivery routine, nothing complicated. But when emergencies or complications arise, you want the team that's trained to perform at a peak level during an emergency, not scrambling, not trying to do things that they really haven't practiced or seen in a while.

So it's something that again, you plan for hopefully a nice uncomplicated, smooth delivery. But you also need to be prepared for more emergencies or catastrophes. And that's, I think what separates us from a lot of facilities is our robust simulation program.

Host: Yeah. And there's nothing like hands-on training. So, what kind of expertise does the Women's Hospital have in simulation?

Dr. Staat: So as far as our simulation team was exceedingly robust but with COVID we did have to reduce some of the scenarios, especially to our outlying centers, just trying to minimize external visitors in and out of other hospitals, but we're looking forward to kind of re-engaging with some of our outreach smaller hospitals.

But in terms of the resources, we do have a coordinator who helps set these up because to run a simulation, you do need expertise on how the scenario should run, also the resources of a mannequin or a fake patient that we try to treat as a real patient. And then also probably the, one of the most important parts is afterwards is the debrief or actually learning what you did well, what areas or gaps you may have and how to improve or work on that.

In terms of simulations, is one of my passions and one of the areas that my myself, I've been an instructor for over 10 years at various national simulation courses, including the Society of Maternal Fetal Medicine that runs a course in Arizona and then the National American College of OB GYN courses that I'll be teaching this year in San Diego this May a course, on emergency. Even though we're a a regional hospital here for the tri-state, we do have experience and leadership on a national level in this area.

Host: Wonderful. What does it take to run a simulation scenario?

Dr. Staat: Again, some of it is the people. So expertise, whether it's the physician like myself or our nurse leadership or our coordinators. And it also takes some of it's actual materials. So you do need some actual mannequins. We were fortunate through a Toyota that donated a van to our simulation outreach efforts. And then you also need the educational piece or the materials as far as how will the scenario run and the actual learning objectives and the kind of knowledge behind it. So it's it does take multiple areas. It's not just a put the mannequin there and go, it's you need the mannequin, you need the providers and the nurses and the expertise, and then you also need kind of the educational material for the backup.

Host: I know if I were an expecting mother, I would certainly prefer to have a team who's had hands-on experience and training and simulation versus a team that's just read about it.

Dr. Staat: Absolutely. That's one of the things that's kind of the scariest parts would be, you know, you don't want to pretend you stayed at a Holiday Express and you learn through osmosis or that your YouTubeing something that how to do it. It's something that you've trained, practiced and tried to go through systematic improvements on what we did well and what we can do better and constantly going through a quality improvement process.

Host: Well, this is just excellent information. Thanks so much for being with us today, Dr. Staat, to fill us in on simulation education. It was great to have you on the podcast.

Dr. Staat: Absolutely. Thank you for the interest. And look forward to talking again.

Host: Our pleasure. We'll have you back for sure. And that wraps up this episode of the podcast series from Deaconess The Women's Hospital. For more information, visit deaconess.com/tsp or call 812-842-4550. Please remember to subscribe, rate and review this podcast and all the other Deaconess Women's Hospital podcasts. For more health tips and updates, follow us on your social channels. This is The Women's Hospital, a Place For All Your Life. I'm Deborah Howell. Thanks for listening and have yourself a great day.