At UT Health San Antonio, Drs. Sarah Page-Ramsey and Patrick Ramsey are using emergency simulations to prepare for the worst — and improve maternal health outcomes.
“This is Maria Felix,” a nurse tells her replacement. “She’s 34 years old, no allergies. Blood type 0-. Delivered a healthy baby boy, 9 pounds and 8 oz, yesterday. She’s complaining of pelvic pain.”
The other nurse nods and turns her eyes to the patient.
“How are you feeling today?” she asks, and then, “Are you still in pain?” A robotic voice answers “yes,” so the nurse tells the patient she’s going to check her bleeding.
“You’re bleeding more than we’d like,” the nurse says. “I’m going to call a doctor.”
Within seconds a doctor in green scrubs and another nurse are bustling around the room, checking the patient’s vitals and bleeding.
“Can we get the hemorrhage kit?” the doctor calls.
Another nurse calls the hospital’s blood bank — they’re going to need several units.
Photos © Shelby Knowles
But this isn’t a real patient, and the blood is corn syrup and food coloring. The nurses and doctors working on the fourth floor of University Hospital, a primary teaching hospital of UT Health San Antonio, are running through an OB emergency simulation under the watch of Dr. Sarah Page-Ramsey and nurse Marisol Breton-Leija.
Ten minutes later the team of nurses and doctors have stabilized the patient — a NOELLE Maternal Care Patient Simulator — and Page-Ramsey is running them through a quick debrief.
“What are some things that went well?” she asks, and members of the team take turns answering. “I felt like we communicated well,” one says. “Someone was noting dosages” of medicine, another offers.
Page-Ramsey nods. “I saw that,” she says. “That was really good.” Then she’s on to the next question: “What could we have done better?”
These emergency drills are an increasingly regular event for the obstetrics team here, and Page-Ramsey wants to hold them even more often. OB emergencies aren’t the only factor affecting maternal health, and simulation training isn’t a cure-all for improving maternal outcomes, but it’s a concrete step, she believes, towards improving the level of care her unit offers.
“This is all driven towards improving patient outcomes,” she explains. “We have a simulation center on the 6th floor, but our main goal is to practice these scenarios in the setting where they’re most likely to occur, so we really prefer to practice on the floor. That way the team is practicing more realistically. They’re actually going to pull medication from where it’s stored, for example. That lets our team experience the actual process, and it helps us identify obstacles early.”
OB emergency simulation drills weren’t always a part of the hospital culture here, but when Page-Ramsey joined the staff of UT Health San Antonio after years in the military, simulations were one of the strengths she knew she could bring with her. She soon began developing a comprehensive curriculum with Breton-Leija, the unit's head of nursing education. They now run simulations for obstetric emergencies like hypertension and shoulder dystocia as well as OB hemorrhage.
The simulations, says Page-Ramsey, have helped the staff communicate more clearly with one another and is helping the team more effectively coordinate care.
“They feel more comfortable when they encounter actual emergencies.”
Dr. Patrick Ramsey, also at University Hospital and UT Health San Antonio, agrees. He says he sees the simulations as a practical step in the state’s fight against maternal mortality and morbidity. As the medical director of the hospital’s maternal transport and outreach team — doctors and nurses from the center regularly visit smaller hospitals in the South Texas region, staging simulations and offering training — he’s taking the practices that have been so effective in San Antonio to a wider community.
“These are emergencies that happen once a year, once a week, once a day, depending on how large the hospital is,” says Ramsey, who is Page-Ramsey's husband. “So we want to work efficiently as a team and feel comfortable in those situations.”
The simulations also help OB teams prepare for the upcoming maternal care designations, which the state of Texas is set to begin rolling out in the next year. “The simulations are part of the designation, and then the goal is to carry those out to other, smaller hospitals to increase their training as well,” Ramsey says.
And that training is effective. “It’s amazing the difference you can see in a team’s confidence level after a day of training," says Allison Moreno, one of the nurses on the outreach team. “They feel really empowered by the end.”
That empowerment is a goal, says Page-Ramsey, and she and her team have worked hard to ensure that the new simulation culture is comfortable for the staff that participate.
“We don’t want people to feel put on the spot or embarrassed,” she says. Rather, the simulations serve as team-building and strengthening exercises. After every simulation the team runs through a de-brief in which members of the team are encouraged to point out challenges and share successes.
“That brings people closer, and helps us respect each other’s roles in the setting and realize what value they bring to the team,” says Page-Ramsey.
The simulations also offer another way to train new physicians and nurses. After the most recent drill, Page-Ramsey says she’s especially proud of the way resident Dr. Brittanie Hagen handled the emergency.
“There’s really this sense of ‘these guys have got this,’” she says. “And that’s what you want when you’re getting ready to send someone out. She’s going to a small, rural hospital, and I know she’s going to be able to take care of her patients, no problem.”