Skill in estimating blood loss declines 9 months after Web-based training
Patient Safety and Quality
Accuracy and timeliness in estimating blood loss is important both in surgery and obstetrics. Yet, clinicians who go through a course of Web-based education on blood loss volume estimation, estimate blood loss less accurately 9 months later, according to a new study. Visual estimation of blood loss remains important, because it is faster than other, more accurate methods that require specialized equipment. The researchers retested 52 of 141 labor and delivery providers who completed an initial Web-based didactic training 9 months after their initial training.
In a pretest before the initial training, the clinicians underestimated the volume of blood loss by an overall 47.8 percent (aggregate accuracy for five simulation stations). The aggregate accuracy improved to a 13.5 percent underestimate for the immediate posttest, but worsened to an aggregate 34.6 percent underestimation at 9 months after training. The 9-month posttest accuracy was significantly better than that observed for the pretest, but significantly worse than that observed for the immediate posttest.
No significant differences in accuracy at the 9-month follow-up were associated with provider type (anesthesiologist, attending obstetrician, nurse), duration of clinical experience, or previous formal training on blood loss accuracy. Three of the simulation stations showed no change in estimation accuracy from the immediate posttest and 9-month test. The researchers suggest that this might be due to the participants having been given information concerning saturated capacity for the laparotomy sponge and a specific rule for estimating blood loss in a bed. The study was funded in part by the Agency for Healthcare Research and Quality (T32 HS00078).
More details are in "Decay in blood loss estimating skills after Web-based didactic training," by Paloma Toledo, MD, MPH, Stanley T. Eosakul, MS, Kristopher Goetz, BA, and others, in the February 2012 Simulation in Healthcare 7(1), pp. 18-21.