Retrospective cohort study of diagnosis–delivery interval with umbilical cord prolapse: the effect of team training

Abstract

Objective To determine whether the introduction of multi‐professional simulation training was associated with improvements in the management of cord prolapse, in particular, the diagnosis–delivery interval (DDI). Design Retrospective cohort study. Setting Large tertiary maternity unit within a University Hospital in the United Kingdom. Sample All cases of cord prolapse with informative case record: 34 pre‐training, 28 post‐training. Methods Review of hospital notes and software system entries; comparison of quality of management for umbilical cord prolapse pre‐training (1993–99) and post‐training (2001–07). Main outcome measures Diagnosis–delivery interval; proportion of caesarean section (CS) in whom actions were taken to reduce cord compression; type of anaesthesia for CS births; rate of low (<7) 5‐minute Apgar scores; rate of admission to neonatal intensive care unit (NICU) (if birthweight >2500 g). Results After training, there was a statistically significant reduction in median DDI from 25 to 14.5 minutes (P < 0.001). Post‐training, there was also a statistically significant increase in the proportion of CS where recommended actions had been performed (from 34.78 to 82.35%, P = 0.003). There was a nonsignificant increase in the use of spinal anaesthesia for CS, from 8.70 to 17.65%, and a nonsignificant reduction in the rate of low Apgar scores from 6.45 to 0% and in the rate of admission to NICU from 38.46 to 22.22%. Conclusions The introduction of annual training, in accordance with national recommendations, was associated with improved management of cord prolapse. Future studies could assess whether this improved management translates into better outcomes for babies and their mothers.

What is the impact of multi-professional emergency obstetric and neonatal care training?

“…Three papers with results from the 'in-house' training in Bristol in the UK were also grouped together [33][34][35]. A synopsis of the 23 studies analysed is given in Table 2.…”

“…• PRactical Obstetric Multi-Professional Training (PROMPT) [19][20][21][22][23][24][25][26][27][28][33][34][35][43][44][45][46]; There were also reports on three locally developed 'in-house' training programmes offered in Tanzania, Denmark and Portugal respectively [17,64,65]. The basic and comprehensive emergency obstetric and neonatal care (BEmONC and CeMONC) training run in many low income countries is often based on the World Health Organization (WHO) training reference manuals [66,67].…”

“…Four studies reported changes in behaviour or practice (level 3c) [17,34,35,54,57]. Thirteen studies had outcomes at level 4, of which 11…”

Crew Resource Management in the Intensive Care Unit: a prospective 3‐year cohort study

“…Rather than focusing on individual failure, CRM aims to identify system flaws and uses standardized communication tools to improve process effectiveness and safety 9. The message of “good people are set up to fail in bad systems – let's figure out how to keep everyone safe” is more easily accepted than “you have a problem that needs to be corrected.”10 This approach is fundamentally different from conventional quality and safety programs in medicine that focus on limiting variation in human behavior through regulations, or scenario‐based team training, when these are not embedded in the more broad CRM approach 11, 12. Contrary to aviation, there is currently no international standard for medical CRM training.…”

A Category One Caesarean Section Process at an Australian Tertiary Obstetric Hospital: Planning to Reduce Decision to Delivery Time

“…It is important to note that reduction of D-D interval requires effective team-work [26] , and attention to processes occurring before and after the establishment of anaesthesia [27] .…”