Simulation-based training and standardised protocol for preventing
massive transfusion in postpartum haemorrhage: a regional retrospective
cohort study
Abstract
Objective: To evaluate obstetrical providers’ behaviours and maternal
outcomes of women transferred with postpartum haemorrhage before and
after introduction of a simulation-based training programme and
standardised protocol Design: A retrospective cohort study Setting: All
institutes operating deliveries in Satsuma Peninsula, Kagoshima
Prefecture, Japan Population and Sample: Patients transferred with
postpartum haemorrhage to Kagoshima City Hospital or Kagoshima
University Hospital were included. Data collected before (period 1:
2015–2017) and after (period 2: 2018–2020) programme initiation were
compared. There were 72 and 131 patients during periods 1 and 2.
Methods: Data from medical records were used to compare providers’
behaviours and outcomes between the two periods. Main outcome measures:
Effectiveness of the simulation-based training and standardised protocol
in postpartum haemorrhage, change in providers’ behaviours, and maternal
outcomes, including massive blood transfusion Results: Changes in
providers’ behaviours were observed after the programme. The rate of
shock index recording increased from 9.7% to 36.6%
(p<0.001), and the rate of using intravenous lines ≥20 gauge
increased from 91.7% to 100% (p=0.0017). The mean shock index on
arrival significantly decreased from 0.85 to 0.77 (p<0.05).
The massive transfusion (red blood cells ≥ 10 units) rate significantly
decreased from 43.1% to 26.0% (p<0.05). Clinical factors
related to massive transfusion were programme attendance, blood loss,
and coagulopathy. Programme attendance reduced the risk of massive
transfusion, while blood loss ≥2,200 g increased the risk. Conclusions:
Introducing the simulation-based training programme and using a
standardised protocol changed the providers’ behaviours and decreased
the massive transfusion rate for postpartum haemorrhage.