Team training in obstetric and neonatal emergencies using highly realistic simulation in Mexico: impact on process indicators

Abstract

BackgroundIneffective management of obstetric emergencies contributes significantly to maternal and neonatal morbidity and mortality in Mexico. PRONTO (Programa de Rescate Obstétrico y Neonatal: Tratamiento Óptimo y Oportuno) is a highly-realistic, low-tech simulation-based obstetric and neonatal emergency training program. A pair-matched hospital-based controlled implementation trial was undertaken in three states in Mexico, with pre/post measurement of process indicators at intervention hospitals. This report assesses the impact of PRONTO simulation training on process indicators from the pre/post study design for process indicators.MethodsData was collected in twelve intervention facilities on process indicators, including pre/post changes in knowledge and self-efficacy of obstetric emergencies and neonatal resuscitation, achievement of strategic planning goals established during training and changes in teamwork scores. Authors performed a longitudinal fixed-effects linear regression model to estimate changes in knowledge and self-efficacy and logistic regression to assess goal achievement.ResultsA total of 450 professionals in interprofessional teams were trained. Significant increases in knowledge and self-efficacy were noted for both physicians and nurses (p <0.001- 0.009) in all domains. Teamwork scores improved and were maintained over a three month period. A mean of 58.8% strategic planning goals per team in each hospital were achieved. There was no association between high goal achievement and knowledge, self-efficacy, proportion of doctors or nurses in training, state, or teamwork score.ConclusionsThese results suggest that PRONTO’s highly realistic, locally appropriate simulation and team training in maternal and neonatal emergency care may be a promising avenue for optimizing emergency response and improving quality of facility-based obstetric and neonatal care in resource-limited settings.Trial registrationNCT01477554

Impact Evaluation of PRONTO Mexico

“…These results complement process indicator findings, which concluded that PRONTO training positively impacts trained providers’ knowledge and self-efficacy and promotes goal achievement 33. Other studies in low-resource settings have also found that provider simulation-based training can positively impact maternal and/or neonatal health outcomes 34,35.…”

Enhancing quality of medical care in low income and middle income countries through simulation-based initiatives: recommendations of the Simnovate Global Health Domain Group

“…It would thus be beneficial to extend the duration of an educational intervention using simulation in order to strengthen a healthcare system. Successful examples include the PRONTO programme and PREVEN network 22 32. These programmes target both formally and informally educated practitioners, and focus on patient outcomes and the development of a network of trained healthcare workers who could potentially pass on the knowledge.…”

“…This showed that neonatal mortality reduction was statistically significant after training with static manikins 21. Another simulation-based neonatal resuscitation training programme, PRONTO, included a team training component aimed at improving the clinical team's response to a neonatal emergency and was implemented in Guatemala after being tested in the UK 22. These are two well-known HICs-funded programmes that show the positive benefits of context-specific simulation use—low technology manikins for low-resource settings, but with high impact.…”

Can an integrated obstetric emergency simulation training improve respectful maternity care? Results from a pilot study in Ghana

“…[16][17][18][19] The PRONTO training kit, the PRONTOPack, includes a hybrid birth simulator called a PartoPants™ (a modified pair of surgical scrubs with anatomical landmarks necessary for delivery) worn by a patient actress (one of the female providers). [16][17][18][19] The PRONTO training kit, the PRONTOPack, includes a hybrid birth simulator called a PartoPants™ (a modified pair of surgical scrubs with anatomical landmarks necessary for delivery) worn by a patient actress (one of the female providers).…”

“…We used provider trainings based on the methodology developed by PRONTO International: a low-tech, highly realistic simulation and team training with facilitated debriefing, to improve identification and management of obstetric and neonatal emergencies and team functioning. [16][17][18][19] The PRONTO training kit, the PRONTOPack, includes a hybrid birth simulator called a PartoPants™ (a modified pair of surgical scrubs with anatomical landmarks necessary for delivery) worn by a patient actress (one of the female providers). The patient actress brings the patient to the center of the care and allows for direct discussion about patient experiences.…”