Multi-professional simulation-based team training in obstetric emergencies for improving patient outcomes and trainees' performance

Fransen, Annemarie; Ven, Jean-Pierre van de; Banga, Franyke; Mol, Ben Willem J.; Oei, S.G.

doi:10.1002/14651858.cd011545.pub2

Cited by 30 publications

(27 citation statements)

References 90 publications

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“…The meta-analysis by Brogaard and colleagues, although finding evidence of potential positive effects of obstetric emergency simulation-based team training on risk of neonatal brachial plexus injury (but with a low-certainty level of evidence) and Apgar scores <7, (though this finding failed to achieve statistical significance), found no evidence of a beneficial effect on other outcomes including hypoxic-ischemic encephalopathy 1. Their findings are similar to other reviews in this area, including a 2020 Cochrane review that concluded multi-professional emergency obstetric training may have positive effects on practical skills, knowledge, and team behavior, but there is little high-certainty evidence of a positive effect on patient outcome 2…”

Section: Commentsupporting

confidence: 58%

The Effects of Obstetric Emergency Team Training on Patient Outcome: A Systematic Review and Meta-Analysis

Brogaard¹,

Lauridsen²,

Løfgren³

et al. 2022

Obstetric Anesthesia Digest

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(Acta Obstet Gynecol Scand. 2022;101:25–36. doi: 10.1111/aogs.14263) Participants in simulation-based team training in obstetric emergencies often report increased confidence in their ability to manage unfolding emergencies that may present in actual practice. However, empirical data that examines the efficacy of such training on impacting clinical outcomes is incomplete. This review assesses the contribution of simulation-based training for health care providers to the outcomes of obstetric emergencies.

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Section: Commentsupporting

confidence: 58%

The Effects of Obstetric Emergency Team Training on Patient Outcome: A Systematic Review and Meta-Analysis

Brogaard¹,

Lauridsen²,

Løfgren³

et al. 2022

Obstetric Anesthesia Digest

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“…Knowing how to work as a team, assign roles and responsibilities and communicate findings may improve the performance of the team. 26 While our study assessed mainly normal births, highly optimised team-based care will also be required to reduce mortality in the case of obstetrical emergencies. 27 Third, improvement interventions may consider management or supervision approaches that pair providers of mixed competency levels.…”

Section: Discussionmentioning

confidence: 99%

“…Second, the propensity for multiple providers during delivery suggests that health worker education should emphasise team-based models of care, perhaps through team drills for emergency scenarios. Knowing how to work as a team, assign roles and responsibilities and communicate findings may improve the performance of the team 26. While our study assessed mainly normal births, highly optimised team-based care will also be required to reduce mortality in the case of obstetrical emergencies 27…”

Section: Discussionmentioning

confidence: 99%

The role of teams in shaping quality of obstetrical care: a cross-sectional study in Dire Dawa, Ethiopia

Gage

Yakob²,

McConnell³

et al. 2022

BMJ Open

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ObjectivesTo examine how characteristics of clinical colleagues influence quality of care.DesignWe conducted a cross-sectional observational study examining the associations between quality of care and a provider’s coworkers, controlling for individual provider’s characteristics and contextual factors.SettingNine health facilities in Dire Dawa Administration, Ethiopia, from December 2020 to February 2021.Participants824 clients and 95 unique providers were observed across the 9 health facilities.Outcome measuresWe examine the quality of processes of intrapartum and immediate postpartum care during five phases of the delivery (first examination, first stage of labour, third stage of labour, immediate newborn care and immediate maternal postpartum care).ResultsFor the average client, 50% of the recommended routine clinical actions were completed during the delivery overall, with immediate maternal postpartum care being the least well performed (17% of recommended actions). Multiple healthcare providers were involved in 55% of deliveries. The number of providers contributing to a delivery was unassociated with the quality of care, but a one standard deviation increase in the coworker’s performance was associated with a 2% point increase in quality of care (p<0.01); this association was largest among providers in the middle quartiles of performance.ConclusionsA provider’s typical performance had a modest positive association with quality of delivery care given by their coworker. As delivery care is often provided by multiple healthcare providers, examining the dynamics of how they influence one another can provide important insights for quality improvement.

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“…This is an evaluation of a single emergency obstetric course, although many exist, and the comparison for PPH related maternal mortality and stillbirth is historical which is acknowledged as imperfect 37 . Deeper analysis into the factors associated with each case of PPH related mortality e.g.…”

Section: Discussionmentioning

confidence: 99%

A mixed methods evaluation of Advanced Life Support in Obstetrics (ALSO) and Basic Life Support in Obstetrics (BLSO) in a resource-limited setting on the Thailand-Myanmar border

McGready¹,

Rijken²,

Turner³

et al. 2021

Wellcome Open Res

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Background: Short emergency obstetric care (EmOC) courses have demonstrated improved provider confidence, knowledge and skills but impact on indicators such as maternal mortality and stillbirth is less substantial. This manuscript evaluates Advanced Life Support in Obstetrics (ALSO) and Basic Life Support (BLSO) as an adult education tool, in a protracted, post-conflict and resource-limited setting. Methods: A mixed methods evaluation was used. Basic characteristics of ALSO and BLSO participants and their course results were summarized. Kirkpatrick’s framework for assessment of education effectiveness included: qualitative data on participants’ reactions to training (level 1); and quantitative health indicator data on change in the availability and quality of EmOC and in maternal and/or neonatal health outcomes (level 4), by evaluation of the post-partum haemorrhage (PPH) related maternal mortality ratio (MMR) and stillbirth rate in the eight years prior and following implementation of ALSO and BLSO. Results: 561 Thailand-Myanmar border health workers participated in ALSO (n=355) and BLSO (n=206) courses 2008-2020. Pass rates on skills exceeded 90% for both courses while 50% passed the written ALSO test. Perceived confidence significantly improved for all items assessed. In the eight-year block preceding the implementation of ALSO and BLSO (2000-07) the PPH related MMR per 100,000 live births was 57.0 (95%CI 30.06-108.3)(9/15797) compared to 25.4 (95%CI 11.6-55.4)(6/23620) eight years following (2009-16), p=0.109. After adjustment, PPH related maternal mortality was associated with birth before ALSO/BLSO implementation aOR 3.825 (95%CI 1.1233-11.870), migrant (not refugee) status aOR 3.814 (95%CI 1.241-11.718) and attending ≤four antenatal consultations aOR 3.648 (95%CI 1.189-11.191). Stillbirth rate per 1,000 total births was 18.2 (95%CI 16.2-20.4)(291/16016) before the courses, and 11.1 (95%CI 9.8-12.5)(264/23884) after, p=0.038. Birth before ALSO/ BLSO implementation was associated with stillbirth aoR 1.235 (95%CI 1.018-1.500). Conclusions: This evaluation suggests ALSO and BLSO are sustainable, beneficial, EmOC trainings for adult education in protracted, post-conflict, resource-limited settings.

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Multi-professional simulation-based team training in obstetric emergencies for improving patient outcomes and trainees' performance

Cited by 30 publications

References 90 publications

The Effects of Obstetric Emergency Team Training on Patient Outcome: A Systematic Review and Meta-Analysis

The Effects of Obstetric Emergency Team Training on Patient Outcome: A Systematic Review and Meta-Analysis

The role of teams in shaping quality of obstetrical care: a cross-sectional study in Dire Dawa, Ethiopia

A mixed methods evaluation of Advanced Life Support in Obstetrics (ALSO) and Basic Life Support in Obstetrics (BLSO) in a resource-limited setting on the Thailand-Myanmar border

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