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Simulation Training Previews Citywide Plan to Reduce Life-Threatening Complications and Deaths from Childbirth among Women of Color

New Childbirth Simulation at NYC Health + Hospitals/Harlem to Teach Hospital Clinicians on Managing Hemorrhage and Preventing Implicit Bias

Training Is Component of the City's Four-Point Plan, Announced in July, to Reduce Severe Maternal Morbidity and Maternal Mortality Events among Women of Color

Sep 18, 2018

Simulated childbirth and maternal hemorrhage prepare the labor and delivery team for real events.
New York, NY

NYC Health + Hospitals showcased yesterday its new medical simulation training to educate doctors, nurses, and other members of the labor and delivery team by using a patient actor and a manikin newborn to demonstrate best practices in the management of maternal hemorrhage, one of the top causes of pregnancy-related deaths for women of color. The public health system announced it has been selected to train 23 public and private hospitals citywide whose patients are at highest obstetric risk, and it will be the first health system in the country to adopt a comprehensive training course created by the American College of Obstetrics and Gynecologists. The new simulation training is a major component of the city’s four-point plan, announced in July, to reduce severe maternal morbidity and maternal mortality events over the next five years. The City’s plan calls for enhancing maternity care, addressing implicit bias, increasing surveillance, and expanding public education as a way to eliminate disparities in maternal mortality between Black and White women—where the widest disparity exists – and reduce by half the number of severe maternal morbidity events in the five boroughs.

The simulated high-risk birthing scenario conducted by a team at NYC Health + Hospitals/Harlem yesterday is part of the new training program that will be rolled out starting in December to approximately 1,000 labor and delivery staff and other health care professionals who interact with the high-risk patient population, including primary care providers, anesthesiologists, and members of rapid response teams. To facilitate easier, year-round access to the training, the public health system will also open mini-sim labs—one- and two-room satellite simulation training facilities located close to Labor and Delivery units at six public hospitals—to focus exclusively on maternal care. NYC Health + Hospitals will receive $2.87 million to develop a program of training, including the simulation training for maternal hemorrhage. Of that funding, $1.2 million will be used to develop simulation mini-sim labs to be located at NYC Health + Hospitals/Harlem and /Bellevue (in Manhattan), /Lincoln and /Jacobi (Bronx), Elmhurst (Queens), and /Kings County (Brooklyn).

“It’s a privilege to play a key role in the City’s efforts to make childbirth safer for all women, and training clinicians on maternal hemorrhage is an important first step,” said Machelle Allen, MD, chief medical officer of NYC Health + Hospitals. “Giving birth is both stressful and joyous. By improving patient safety and reducing the reasons for stress, we can make a joyous event even more so.”

“Maternal hemorrhage is an important focus for training; because it doesn’t happen every day, it is difficult to keep clinical skills fresh, while preparedness can make all the difference in outcomes,” said Komal Bajaj, MD, clinical director of the NYC Health + Hospitals/Simulation Center. “Our multifaceted training is highly effective at reinforcing the expertise and skills needed to make childbirth as safe as possible.”

Among those leading the simulation training effort are (standing, from left) Katie Walker, MBA, RN, director and assistant vice president of the Simulation Center; Michael Meguerdichian, MD, MHPED, clinical director and medical director of the Simulation Center at NYC Health + Hospitals/Harlem; Eboné Carrington, chief executive officer of NYC Health + Hospitals/Harlem; Herminia Palacio, MD, New York City’s deputy mayor for Health and Human Services; Machelle Allen, MD, chief medical officer of NYC Health + Hospitals; and Komal Bajaj, MD, MS-HPEd, clinical director of the Simulation Center.

Demonstrating the City’s commitment to reducing maternal morbidity and mortality, Deputy Mayor for Health and Human Services Dr. Herminia Palacio monitored the simulation exercise. “The birth of a child should be a joyous moment, not a time for mothers to be concerned about potential fatal health complications from labor,” said Dr. Palacio. “That’s why in New York City, we have launched a comprehensive plan to reduce high rates of severe maternal morbidity and maternal mortality among women of color. This simulation training—the first of many more being rolled out across New York City hospitals—will help ensure doctors are well prepared to handle serious complications that may arise in the labor delivery room, and which will ultimately save the lives of mothers across our communities.”

In the simulation exercise, an obstetric team delivered a “baby”—whose “mother” was part live actor, part high-tech manikin. The “mother” then experienced a postpartum hemorrhage. The team’s response to the emergency included consenting the patient for blood transfusion, quantifying blood loss, administering medications to decrease blood loss, and calling for additional resources. Once the scenario ended, the participants engaged in a debriefing to reinforce the use of obstetric best practices established by the American College of Obstetrics and Gynecologists/District II, as well as to reflect on risk factors, such as Type 2 diabetes.

“The intensity of the simulation feels very real,” said Arlene Ignaccio-Blattman, MD, OBGYN Attending at NYC Health + Hospitals/Harlem, who participated in the exercise. “I wanted to make sure to do things right to save this mother’s life, and it’s helpful to go through the training and learn afterwards without anyone’s life really being at risk. It better prepares me for when the real event happens.”

Other aspects of the training include:

  • Strategies to optimize health prior to pregnancy;
  • Prenatal identification and counseling for hemorrhage risks, including high-risk conditions such as anemia, fibroids, hypertensive disease, previous Caesarean section, and disorders of the placenta;
  • Prenatal strategies to address anemia, such as iron supplementation, blood transfusion, and counseling for additional blood-product alternatives;
  • Appropriate identification and counseling of hemorrhage risks at the time of labor and delivery;
  • Strategies to prevent hemorrhage, including active management of the third stage of labor;
  • Prompt recognition and escalation to address early hemorrhage; and
  • Multidisciplinary approaches to treat maternal hemorrhage, including surgical management of hemorrhage and critical care of women experiencing hemorrhage.

The course also includes elements that have been a part of traditional maternal hemorrhage training, including teamwork, patient-centered communication, and critical actions during a postpartum hemorrhage.

Additional funding is anticipated for the public health system to spread the training throughout the city’s 23 hospitals with the highest-risk obstetric populations. NYC Health + Hospitals staff will train the trainers—teaching three trainers from each hospital how to lead a successful program to reduce maternal morbidity and mortality.

The simulation training is just the latest contribution of the public health system to promoting greater maternal safety in the city and state. NYC Health + Hospitals is the only health system or hospital in New York State identified by the American College of Obstetricians and Gynecologists as a collaborator on its Safe Motherhood Initiative work. The health system also plays an active role on both New York State’s maternal mortality review committee and New York City’s Maternal Mortality and Morbidity Review Committee.

Today’s demonstration was also a component of NYC Health + Hospitals’ recognition of national Healthcare Simulation Week. The event at NYC Health + Hospitals/Harlem is one of ten scheduled between September 17 and 21, showcasing the public health system’s use of simulation to promote best practices and improve patient safety.