The effects of obstetric emergency team training on patient outcome: A systematic review and meta‐analysis

Abstract

Introduction Little is known about the optimal simulation‐based team training in obstetric emergencies. We aimed to review how simulation‐based team training affects patient outcomes in obstetric emergencies. Material and methods Search Strategy: MEDLINE, Embase, Cochrane Library, and Cochrane Central Register of Controlled Trials were searched up to and including May 15, 2021. Selection criteria: randomized controlled trials (RCTs) and cohort studies on obstetric teams in high‐resource settings comparing the effect of simulation‐based obstetric emergency team training with no training on the risk of Apgar scores less than 7 at 5 min, neonatal hypoxic ischemic encephalopathy, severe postpartum hemorrhage, blood transfusion of four or more units, and delay of emergency cesarean section by more than 30 min. Data collection and analysis: The included studies were assessed using PRISMA, EPCO, and GRADE. Results We found 21 studies, four RCTs and 17 cohort studies, evaluating patient outcomes after obstetric team training compared with no training. Annual obstetric emergency team training may reduce brachial plexus injury (six cohort studies: odds ratio [OR] 0.47, 95% CI 0.33–0.68; one RCT: OR 1.30, 95 CI% 0.39–4.33, low certainty evidence) and suggest a positive effect; but it was not significant on Apgar score below 7 at 5 min (three cohort studies: OR 0.77, 95% CI 0.51–1.19; two RCT: OR 0.87, 95% CI 0.72–1.05, moderate certainty evidence). The effect was unclear for hypoxic ischemic encephalopathy, umbilical prolapse, decision to birth interval in emergency cesarean section, and for severe postpartum hemorrhage. Studies with in situ multi‐professional simulation‐based training demonstrated the best effect. Conclusions Emerging evidence suggests an effect of obstetric team training on obstetric outcomes, but conflicting results call for controlled trials targeted to identify the optimal methodology for effective team training.

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

“…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 Only 4 of the 21 studies included in Brogaard's metaanalysis were randomized controlled trials, the remainder were retrospective cohort studies.…”

Evaluating the impact of a maternity and neonatal emergencies education programme in Australian regional and rural health services on clinician knowledge and confidence: a pre-test post-test study

“… 16 31 34 A recent systematic review and meta-analysis has found weak evidence to support an effect on brachial plexus injury; and a positive but non-significant effect on Apgar scores below 7 at 5 min; the evidence supporting other clinical outcomes was less clear. 35 Indeed, emergency obstetric training programme evaluations routinely demonstrate changes in the first three levels of the Kirkpatrick Evaluation Model: a systematic literature review assessed the evidence for the effectiveness of training in emergency obstetric care, and included 101 studies. 10 Changes in level 1 and/or level 2 were investigated in 68 of these, with level 3 assessed in 51 studies, and level 4 in 21.…”

“…Further, the low response rate at 6 months and 12 months post-MANE, along with the characteristics of survey respondents may have affected responses provided at these time points, and the lack of clinical outcome data further limits the interpretation of this study. It is worth noting, however, that the evidence supporting clinical outcomes following obstetric training programmes is unclear, 35 or the length of time they are sustained. 40 …”

GENESISS 1—Generating Standards for In-Situ Simulation project: a scoping review and conceptual model

“…Efforts to standardise ISS terms and concepts and develop an integrated model of learning is required [ 2 , 4 , 17 ]. Previous reviews have focused on ISS for education and training of healthcare professionals [ 18 ], ISS in operating rooms [ 19 ], effect on patient outcomes [ 20 ] or have included ISS within a broader simulation approach within acute care settings [ 21 ], for caesarean section training [ 22 ] and obstetric emergency teams [ 23 ]. Reviews have highlighted a limited but promising evidence base for ISS and reported high variability of ISS approaches to design, delivery, and evaluation [ 18 – 23 ].…”