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Labor and Delivery CRM Course Details

 

Introduction

Patient safety is now recognized as an integral component of healthcare. Many efforts are underway to reduce the occurrence of medical errors and the injuries and malpractice claims that result from them. Obstetrical and surgical adverse events involving failures of team performance are among the major areas of attention for the reduction of adverse events and liability claims. The increasingly high cost of obstetrical malpractice claims has made patient safety and error reduction priorities for loss prevention interventions.

Simulation based training has been a standard of practice worldwide for many years in the aviation industry. Similarly, Anesthesia, Emergency Medicine and Neonatology have for several years been using simulation-based training to refine team-building and procedural skills. The Anesthesia Departments of Harvard Medical School (HMS) have been working with the Center for Medical Simulation (CMS) since 1994, using simulation to teach skills such as leadership, communication, and resource and support management techniques necessary for effective team performance during critical events. Currently, all Anesthesia faculty participate in simulation-based training and receive malpractice insurance premium discounts.

The Center for Medical Simulation and Harvard’s Risk Management Foundation (RMF) have developed a Labor and Delivery Crisis Resource Management (CRM) course specifically for their Obstetrical Nurse and Physician staff. Harvard RMF/CRICO will provide a 10% discount for annual obstetrical malpractice premiums for those physicians who complete the following 3 requirements:

  1. L&D CRM course
  2. RMF CME website coursework
  3. Short test on CRICO Obstetrical guidelines

This 10% premium discount applies for a term of three years after completing these three requirements. Although the CRM pilot programs were completely funded by RMF, Obstetricians, Obstetrical Nurses, and non-CRICO insured Anesthesiologists will be charged a fee to participate in the L&D CRM course.

ProMutual Group also offers their insured obstetricians an annual premium discount for completing the Labor and Delivery Crisis Resource Management courses. Please contact your assigned agent directly for further details on how to obtain this discount.



Learning Teamwork and Crisis Resource Management in Labor & Delivery


Course Description

The Labor and Delivery CRM course will be held at the Center for Medical Simulation beginning in March 2003. It is an experiential six-hour program focusing on event management during simulated clinical practice. The participants in this course will include Obstetricians, Obstetrical Nurses and Obstetrical Anesthesiologists, as collaboration and teamwork among these groups is so important during obstetrical events.

The Center is a realistic medical setting, equipped with all the supplies and devices normally found in Labor and Delivery. Simulated clinical scenarios and obstetrical procedures are conducted using a computerized mannequin and fetal heart rate simulator equipment. Some obstetrical procedures cannot be easily simulated, and will require the participant to play-act. Simulated events will be videotaped so that teammates can view their performance in structured group debriefings facilitated by trained CMS instructors. Practice and supportive feedback will be provided to enhance teamwork skills for the reduction of adverse events and medical errors in actual clinical settings.

The course curriculum is derived from review of obstetrical claims data, consultation with obstetrical leadership, experiences with Anesthesia CRM courses, and feedback from L&D CRM programs that have been held over the past two years.  

The Labor and Delivery CRM course will focus on the following objectives derived from review of obstetrical claims data, consultation with obstetrical leadership, Anesthesia CRM courses, and feedback from a series of L&D CRM pilot programs conducted over the past year:

  1. Factors degrading long-term vigilance in Labor & Delivery
    1. Work overload
    2. Hubris
    3. Production pressures
    4. Fixation and being stuck in mental models that seem rational but aren’t
    5. Tolerance, accommodation and being falsely reassured
    6. Fatigue
  2. Communication strategies in Event Management
    1. Sharing information with all team members
    2. Importance of closed-loop communications
    3. Introducing yourself, your level of experience to team and vice versa
    4. Lower threshold calling for help
    5. Assertiveness techniques
  3. Strategies for debriefing events and disclosing medical errors
    1. Being accountable as a member of the team
    2. Apologizing without accepting blame
    3. Talking to the patient and family

Register Now July thru September Dates available
Course Credits
Open Course Dates

Learning Teamwork and Crisis Resource Management for Labor and Delivery Physicians II


Learning Teamwork and Crisis Resource Management for Labor and Delivery Physicians II courses are designed for those who have previously taken Learning Teamwork and Crisis Resource Management for Labor and Delivery Physicians I courses, refining and advancing principles of crisis resource management (CRM) that have been taught in the simulated clinical setting for application in the real clinical setting.

L & D II Course Curriculum


  1. Overview of CRM Principles
    1. Application to real clinical settings
    2. Cross monitoring
    3. Situation awareness
  2. Communication strategies in Event Management
    1. Handoffs
    2. Structured communication such as SBAR
    3. Assertion techniques such as “Two Challenge”
  3. Managing and disclosing medical errors
    1. Discuss current strategies for managing risk
    2. Apology laws
    3. Documentation-medical, legal considerations
  4. Developing a culture of safety
    1. High reliability organizations
    2. Role of Rapid Response Teams
    3. Debriefing routine and critical events
    4. Strategies for change

Register Now July thru September Dates available
Course Credits
Open Course Dates

 

Labor and Delivery Course Co-Directors

Roxane Gardner, MD is a board-certified Obstetrician-Gynecologist and Assistant Professor of Obstetrics, GYnecology and Reproductive Biology at Harvard Medical School. She's been a faculty member of the Department of Obstetrics and Gynecology at Brigham and Women's Hospital since 1999. Prior to that, she served for 10 years as a member of the full time faculty at Boston's Beth Israel Deaconess Medical Center. In 2002, she's become a faculty member of the Center for Medical SImulation where she's helped to design and implement a human simulation-based team training program for labor and delivery personnel. She's currently expanding her work in obstetrical simulation-based tracing and exploring ways to apply this training to address racial/ethnic health disparities at the provider-level. These areas of research are part of her overall efforts to improve patient safety and reduce medical errors while pursuing a doctoral degree in Health Policy and management at Harvard's School of Public Health

Toni Beth Walzer, MD is a board-certified Obstetrician-Gynecologist, Assistant Clinical Professor of Obstetrics, Gynecology, and Reproductive Biology at Harvard Medical School, and member of the active staff of Brigham & Women's Hospital since 1981. After over 20 years as a practicing clinician, she is now involved in patient safety and reduction of medical errors in the field of Obstetrics and Gynecology. She is actively engaged in teaching students at Harvard Medical School, and serves as an Ob-Gyn malpractice claims consultant for both Harvard's Risk Management Foundation, and is a member of ProMutual Group’s In-House Review Panel. She has served as a faculty member of the Center for Medical Simulation since January 2002, and as co-director of the course, is involved in the program design and implementation of simulation-based team training and crisis resource management for labor and delivery personnel.