Board 525 - Technology Innovations Abstract Development of a Multiplayer Virtual-Reality Obstetric Hemorrhage Simulation Program (Submission #747)

Introduction/Background Obstetric hemorrhage (OH) is a leading cause of maternal morbidity and mortality worldwide. Multidisciplinary initiatives are needed to improve outcomes in women experiencing OH. To this end, the Joint Commission recommends the use of clinical protocols for OH management.1 These protocols must be practiced by the team to ensure effectiveness, but manikin-based simulations can be expensive and challenging to coordinate with all team members. In partnership with the Virtual Heroes division of Applied Research Associates, Inc., we developed a web-based computer OH simulation for the purpose of training and evaluating participants in use of an OH protocol as well as reinforcing teamwork and communication. Methods The Obstetric Hemorrhage Scenario is an immersive multiplayer learning application built using the [email protected] platform and deployed via web plugins. Participant communication is accomplished via voice over IP (VoIP) and text chat windows. Participant move avatars through a virtual patient room and are able to interact with both the patient and objects in the room. Scenario content is constructed around an OH due to uterine atony in a primigravida. The instructor controls all patient physiology by either manual control or macro-based controls, and can adjust patient vitals and appearance based on participant therapeutic interventions. Participants are able to perform physical exam, administer fluids and medications, order labs, order and transfuse blood components, and view patient data in an electronic health record. Teamwork and communication behaviors of participants are observed and evaluated according to TeamSTEPPS principles. Knowledge learning objectives include: 1) early recognition of the signs of uterine atony; 2) appropriate use of uterotonics; 3) activation of the OH protocol; and 4) ordering laboratory studies and transfusing blood products according to the OH protocol and laboratory data. Key elements of transfusion practice observed include two-person bedside verification against the patient armband, ensuring ABO compatibility of blood products, and observation of blood product expiration times. Simulation build is complete and currently undergoing multidisciplinary beta testing in both the United States and Australia, with plans to incorporate this simulation into medical student training in 2013. Results: Conclusion Our construction of a web-based virtual reality simulation has created a training tool that emphasizes team communication, evidence-based obstetric interventions, safe transfusion practices, and appropriate blood management for OH. This customizable, cost-effective tool allows for institution-wide training of team members in the OH protocol and provides a widely available opportunity for research into individual- and team-decision making during OH management without the need for geographic co-localization of participants. References 1. Joint Commission on Accreditation of Healthcare Organizations, USA. Preventing Maternal Death. Sentinel Event Alert, January 26, 2010; 44:1-4. Disclosures CSL Behring, Octapharma, TEM Systems Inc. Abbott, Pfizer Guidepoint, Maven Applied Research Associates-proprietary interest in jointly developed projects.