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With the help of simulators and training drills, nurses and physicians at Riddle Memorial Hospital in Media, Pa., are working together to improve outcomes for delivering mothers and their babies. The creation of obstetrical rapid response teams prepares healthcare workers to quickly intervene during fetal distress, maternal hemorrhage, shoulder dystocia, or other emergency situations.

“These are things that do not happen every day,” says Barb Kurtz, RN, MSN, director of Women’s Health at Riddle Memorial. “We want [the caregivers] at their best during these stressful situations.”

The teams are modeled after a program in place at the University of Pittsburgh Medical Center’s Magee-Women’s Hospital. Magee-Women’s created an obstetric-specific crisis team, called Condition O, three years ago to address obstetrical emergencies. The hospital has found it works well, says Karen Stein, RN, MSEd, CCRN, a clinical education specialist at Magee-Women’s.

“The emphasis is on communication and working together as a team,” Stein says. “We believe team training truly is effective in building teams that provide optimal patient outcomes, and we’d like to share that.”

Helen Kuroki, MD, director of continuing medical education for Riddle’s department of obstetrics/gynecology, invited Stein and Gabriella Gosman, MD, the developer of the obstetrics crisis team, to help Riddle tailor its program and training techniques to the community hospital setting.

The Training

Stein, Gosman, and other professionals from Magee-Women’s assisted with Riddle’s first training session for nurses and physicians. They taught the Riddle teams to use closed-loop communication, a technique for giving clear directions used by the military and NASCAR pit crews. For example, a physician asks a nurse to complete a specific task, such as “Mary, draw blood for a CBC.” When finished, the nurse reports the task is complete.

Team members also were introduced to Web-based modules that describe the ideal actions clinicians should take in various emergencies — maternal hemorrhage, shoulder dystocia, or an emergency cesarean section, for example. Then, simulator mannequins are programmed to re-create an obstetrical crisis.

During a drill, the teams jump into action as trainers videotape the mock response. Nurses hang IVs, administer medications, and provide hands-on care. Then the mannequin is wheeled into the operating room, and the team prepares for surgery.

Afterward, the facilitators and team members watch the video of the drill and discuss what went right and what could be changed to improve outcomes. “Video is a powerful tool to watch themselves communicate with each other,” Stein says, adding that simulators offer a safe environment to hone skills and improve communication techniques.

Kuroki says everyone shares a sense of accomplishment when things go well.

“It’s a great opportunity to break down the walls between physicians and nurses and get together on a level playing field,” Kurtz says. “Nurses walk away feeling better about their roles.”

Riddle has trained at least 20 nurses to respond to obstetric emergencies; all of the hospital’s obstetricians have completed the training. “Each run-through was better than the one before,” Kuroki says. “When we understand what our tasks are and we do them repeatedly, we get better and better at them — and faster.”

The Team in Action

When an obstetric emergency occurs at Magee-Women’s, the team that responds includes an obstetrician, an OB/GYN resident, a labor and delivery nurse, a critical care fellow, an anesthetist, a respiratory therapist, an administrative nurse, and a neonatal response team. These first responders will assess the emergency and dismiss personnel not needed for the situation, such as sending the neonatal team away if there’s no delivery.

“The goal is to stabilize,” says Stein, adding that the team responds to an average of 60 to 100 calls per year. The hospital delivers 9,000 to 10,000 babies annually.

The obstetric-specific crisis response team relies on administrative support and makes every effort to educate staff about what the team does and what to expect when the team arrives. This is important even in facilities with a separate medical crisis response team, Stein says.

“Initiating an emergency cesarean section can be several minutes faster by getting the key providers in the room and allowing them to work together,” Stein says.

Adjusting Model to Needs

At Riddle, the obstetric rapid response team includes a neonatal nurse, the house shift supervisor, an obstetrician or the house doctor, and a patient transport person to hustle blood specimens to the lab. When an obstetrical crisis arises, the team will respond and promptly take action to stabilize the patient. If a postpartum hemorrhage occurs, for example, the team arrives with a hemorrhage kit, complete with all the medications and equipment needed to manage the situation.

Riddle continues to train personnel and has not yet officially activated its Condition O response team.

“But we have had a number of situations where we have utilized this [training] and have moved much more quickly than we were able to in the past,” Kuroki says. “In the end, we expect the people to benefit will be the mom and the baby.”

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Debra Anscombe Wood, RN, is a freelance writer.
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