OHSU and NASA Team To Improve Childbirth Safety

09/26/05  Portland, Ore.

Oregon Health & Science University and NASA, the agency that sends astronauts into space, are launching a different type of mission. Their new study, "Using Military and Aviation Simulation Experience to Improve Rural Obstetric Care,"  is very down-to-earth, reducing errors in emergency, high-risk births.

The goal of this project according to Jeanne-Marie Guise, M.D., M.P.H., the principal investigator, is to bring the space agency's simulation technology and team performance training, proved to improve safety in aviation, into the field of obstetrics. OHSU was awarded the $480,000, two-year grant from the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ).   The training will use a high-tech pregnant manikin  that will be programmed to give birth during various life-threatening emergencies.  A standardized curriculum (CORDS) will be developed at OHSU and tested in several rural hospitals in Oregon.  This project promises to be transformational for Oregon's emergency preparedness, and for childbirth safety.

More than 75 infants die each day in the United States. It's estimated that two-thirds of neonatal deaths or permanent disabilities occurring during childbirth are due to human factors, such as communication errors, and almost half due to staff competency issues, according to the Joint Commission on Accreditation of Healthcare Organizations. The CORDS curriculum focuses on these factors, and provides clinicians with important skills for efficient communication and knowledge for high-stress emergency situations.

"The whole idea is that there are medical emergencies that don't happen all that often,  but when they do, the staff needs to be on the same page. You only have seconds to make decisions and it requires the whole team communicating. During these rare emergencies, the whole team needs to be moving quickly and intelligently," said Guise, associate professor of Obstetrics and Gynecology, medical informatics and clinical epidemiology, and public health and preventive medicine, OHSU School of Medicine; member of the Center for Women's Health; and director of the State Obstetric and Pediatric Research Collaborative (STORC).

 All that sounds good for Oregon patient care. It's even better. Once the curriculum is proved effective, it is intended to be available on compact disc so that busy hospitals can use it locally as frequently as they like to maintain and improve their clinical skills.

AHRQ's Partnerships in Implementing Patient Safety grants are intended for projects that focus on reducing medical errors. Many of the projects, including  OHSU's, will apply interventions to improve health care team communications, often a source of medical errors. The results of the project will:  provide toolkits that can be used throughout the country to improve the process of care and promote safety; demonstrate how information technology and simulation education can be used to support a statewide safety culture; and to create a model on how to use and evaluate the effectiveness of simulations to maintain skills and enhance safety and care.

Partners for the CORDS curriculum development include: OHSU, NASA, the U.S. military, and the American College of Obstetricians and Gynecologists. Research sites include: OHSU; the Oregon Rural Practice-based Network; Silverton Hospital, Silverton; Lake District Hospital, Lakeview; Harney District Hospital, Burns; St. Elizabeth Health Services, Baker City; Providence Hood River Hospital, Hood River; Good Samaritan Regional Medical Center, Corvallis; The Corvallis Clinic; and Madigan Army Medical Center Fort Lewis, Wash.

Some examples of the emergencies they expect to train for include postpartum hemorrhage, shoulder dystocia and emergent Caesarean section deliveries, where minutes and seconds can really make a difference. A secure Web site has been created to enable anonymous protected sharing of experiences, errors or close calls that occurred or almost occurred  in real life so researchers can continue to build simulations that address common issues in real-life obstetrics. The Web site provides a source for information sharing and community building. It can be found at www.storc.org.