Eclampsia Management: Team Improvement Opportunities Identified in High-Fidelity Simulations

INTRODUCTION: Eclampsia is an uncommon obstetric emergency that can have significant consequences for both the mother and fetus. The objective of this qualitative study was to evaluate team performance with high-fidelity simulation and attempt to identify areas where additional training may be indicated for the treatment of eclampsia. METHODS: Participants at a national critical care obstetrics course received morning didactic sessions after which they were divided into teams and then participated in high-fidelity simulations of obstetric emergencies including a case of severe hypertension and eclampsia. Facilitators completed standardized checklist assessments of medical management for each group's performance. Critical actions were documented, and pre-defined significant errors, such as attempting intubation or performing a cesarean section during the eclamptic seizure, were also tracked. Data regarding performance was evaluated with descriptive statistics. This study was determined to be exempt by the hospital’s institutional review board (IRB). RESULTS: A total of 170 teams had complete data available for the eclampsia simulations conducted between 2014-2019. Almost a quarter of the teams (23.6%) did not do a good job in protecting the patient (turning to side/putting bedrails up) during the seizure and 14.2% did not administer magnesium sulfate correctly (dose/duration of infusion). In addition, 11.2% did not continue magnesium for prophylaxis after the seizure and 10.6% also attempted to intubate the patient during the 2-minute eclamptic seizure. CONCLUSION: There were multiple areas of suboptimal performance identified during high-fidelity eclampsia simulation of a large number of obstetric provider care teams. Future training efforts should be focused on these specific deficits in order to improve performance.