Presented September 3, 2025 at the 2025 APSF Stoelting Conference on “Transforming Maternal Care: Innovations and Collaborations to Reduce Morbidity and Mortality”
SUMMARY
Kokila Thenuwara, MD’s presentation details an innovative approach using mobile, in-situ simulation to address the critical challenges facing rural maternal health, primarily caused by the closure of obstetric units and resulting low-volume exposure to emergencies. The intervention focuses on providing standardized, skills-based training—aligned with state perinatal quality bundles—to remaining Level 1 hospitals and, critically, to Emergency Departments that must manage unexpected deliveries and transfers. A central component of the training is improving communication between bedside staff and off-site providers to enable rapid, prepared responses for time-sensitive obstetric emergencies.
Key Points:
- Maternal Care Desert Crisis
Rural hospital and OB unit closures lead to maternal care deserts [03:05, 04:05]. This results in staff at remaining low-volume hospitals (EDs, Level 1 OB units) having limited specialized training and infrequent exposure to obstetric emergencies, leading to difficulties in skill maintenance [05:24, 05:42]. - Mobile Simulation as Intervention
A mobile, in-situ simulation unit was deployed across the state (e.g., to hospital bays, EDs, fire stations) to deliver skills training directly to resource-limited facilities [07:55, 08:32]. This decentralized approach targets skill gaps where they occur. - Curriculum Standardization
Simulations for OB units were conducted in tandem with the state’s Perinatal Quality Care Collaborative (PQC) safety bundles (e.g., obstetric hemorrhage, severe hypertension) to ensure the care provided is standardized and reflects current best practices statewide [10:26, 12:08]. - SBAR for Off-Site Providers
Training heavily emphasized communication with providers who are not in-house [12:39]. Nurses were taught to use SBAR to effectively convey the patient’s condition and secure orders, allowing them to prepare the room (e.g., massive transfusion components, hemorrhage devices) before the off-site provider’s arrival, minimizing critical time delay [12:49, 13:16]. - Team-Based Emergency Response
Simulations included all available personnel (L&D nurses, unit clerks, ED staff) to train a cohesive, multidisciplinary response team, essential in low-volume settings where minimal staffing during an emergency is a key vulnerability [06:16, 13:42].
ABOUT THE SPEAKER(S)
Kokila Thenuwara, MD
Clinical Professor, Obstetric Anesthesia
Vice Chair for Faculty Affairs and Development,
Department of Anesthesia,
University of Iowa
Kokila N Thenuwara MBBS MD MME MHCDS is a Clinical Professor in Obstetric Anesthesia and the Vice Chair for Faculty Affairs and development, Department of Anesthesia at the University of Iowa.
She obtained her medical education at North Colombo Medical College, Ragama, Sri Lanka. She completed her internship in internal medicine, and residency in Anesthesiology at the University of Iowa. She obtained her Master’s in Medical Education from the University of Iowa and Master’s in Health Care Delivery Science from Dartmouth College, and is currently following a Certification in Diversity, equity, Inclusion and belonging from the Harvard Extension school.
She is the Director for the New Faculty Development Program and was the Chair of the Best Practices Committee at the department of Anesthesia, University of Iowa.
She is the chair of Subcommittee for Simulation based Education, supported by a HRSA grant, and an appointed member of the Iowa State Maternal Mortality Review Committee.
She is the taskforce Chair for DEI for the American Board of Anesthesiology (ABA) and is also an applied examiner, question editor and OSCE developer for the ABA, specializing in ethics and DEI.
She is the 2024 recipient of the IDEAL ( Inclusion, Diversity, Equity, Acceptance and Leadership ) award given by the Association for University Anesthesiologists.
She considers it a privilege to be a member of the Iowa State Maternal Mortality review committee and is grateful for the opportunity to be of service to her State, especially women who are vulnerable, and mothers who are at risk of dying. She hopes that her contribution through this committee and her work with the HRSA grant will help avert deaths of mothers in Iowa and beyond.
