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Sansregret A, Garber A, Freire-Lizama T, Monton L, Mueller V, Papalia N, Ruiter PJA, Shore EM, Suri M. Consensus Statement No. 434: Simulation in Obstetrics and Gynaecology. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:214-226.e1. [PMID: 37055148 DOI: 10.1016/j.jogc.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
OBJECTIVE To provide a comprehensive and current overview of the evidence for the value of simulation for education, team training, patient safety, and quality improvement in obstetrics and gynaecology, to familiarize readers with principles to consider in developing a simulation program, and to provide tools and references for simulation advocates. TARGET POPULATION Providers working to improve health care for Canadian women and their families; patients and their families. OUTCOMES Simulation has been validated in the literature as contributing to positive outcomes in achieving learning objectives, maintaining individual and team competence, and enhancing patient safety. Simulation is a well-developed modality with established principles to maximize its utility and create a safe environment for simulation participants. Simulation is most effective when it involves interprofessional collaboration, institutional support, and regular repetition. BENEFITS, HARMS, AND COSTS This modality improves teamwork skills, patient outcomes, and health care spending. Upholding prescribed principles of psychological safety when implementing a simulation program minimizes harm to participants. However, simulation can be an expensive tool requiring human resources, equipment, and time. EVIDENCE Articles published between 2003 and 2022 were retrieved through searches of Medline and PubMed using the keywords "simulation" and "simulator." The search was limited to articles published in English and French. The articles were reviewed for their quality, relevance, and value by the SOGC Simulation Working Group. Expert opinion from relevant seminal books was also considered. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE All health care professionals working to improve Canadian women's health, and relevant stakeholders, including granting agencies, physician/nursing/midwifery colleges, accreditation bodies, academic centres, hospitals, and training programs. RECOMMENDATIONS
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Sansregret A, Garber A, Freire-Lizama T, Monton L, Mueller V, Papalia N, Ruiter PJA, Shore EM, Suri M. Déclaration de consensus n o 434 : Simulation en obstétrique et gynécologie. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:227-240.e1. [PMID: 37055149 DOI: 10.1016/j.jogc.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
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Brazil V, McLean D, Lowe B, Kordich L, Cullen D, De Araujo V, Eldridge T, Purdy E. A relational approach to improving interprofessional teamwork in post-partum haemorrhage (PPH). BMC Health Serv Res 2022; 22:1108. [PMID: 36050714 PMCID: PMC9438096 DOI: 10.1186/s12913-022-08463-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/16/2022] [Indexed: 12/01/2022] Open
Abstract
Background Post-partum haemorrhage (PPH) is an obstetric emergency that requires effective teamwork under complex conditions. We explored healthcare team performance for women who suffered a PPH, focusing on relationships and culture as critical influences on teamwork behaviours and outcomes. Methods In collaboration with clinical teams, we implemented structural, process and relational interventions to improve teamwork in PPH cases. We were guided by the conceptual framework of Relational Coordination and used a mixed methods approach to data collection and analysis. We employed translational simulation as a central, but not singular, technique for enabling exploration and improvement. Key themes were identified from surveys, focus groups, simulation sessions, interviews, and personal communications over a 12-month period. Results Four overarching themes were identified: 1) Teamwork, clear roles and identified leadership are critical. 2) Relational factors powerfully underpin teamwork behaviours—shared goals, shared knowledge, and mutual respect. 3) Conflict and poor relationships can and should be actively explored and addressed to improve performance. 4) Simulation supports improved team performance through multifaceted mechanisms. One year after the project commenced, significant progress had been made in relationships and systems. Clinical outcomes have improved; despite unprecedented increase in labour ward activity, there has not been any increase in large PPHs. Conclusions Teamwork, relationships, and the context of care can be actively shaped in partnership with clinicians to support high performance in maternity care. We present our multifaceted approach as a guide for leaders and clinicians in maternity teams, and as an exemplar for others enacting quality improvement in healthcare.
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Affiliation(s)
| | - Darren McLean
- Gold Coast Hospital and Health Service, Gold Coast, Australia
| | - Belinda Lowe
- Gold Coast Hospital and Health Service, Gold Coast, Australia
| | - Lada Kordich
- Gold Coast Hospital and Health Service, Gold Coast, Australia
| | - Deborah Cullen
- Gold Coast Hospital and Health Service, Gold Coast, Australia
| | | | - Talia Eldridge
- Gold Coast Hospital and Health Service, Gold Coast, Australia
| | - Eve Purdy
- Gold Coast Hospital and Health Service, Gold Coast, Australia
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Brogaard L, Glerup Lauridsen K, Løfgren B, Krogh K, Paltved C, Boie S, Hvidman L. The effects of obstetric emergency team training on patient outcome: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2021; 101:25-36. [PMID: 34622945 DOI: 10.1111/aogs.14263] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/19/2021] [Accepted: 08/27/2021] [Indexed: 11/30/2022]
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.
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Affiliation(s)
- Lise Brogaard
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kasper Glerup Lauridsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Medicine, Randers Regional Hospital, Randers, Denmark
| | - Bo Løfgren
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Medicine, Randers Regional Hospital, Randers, Denmark
| | - Kristian Krogh
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Paltved
- Department of Human Resources, Medical simulation in Central Denmark Region (MidtSim), Aarhus, Denmark
| | - Sidsel Boie
- Department of Obstetrics and Gynecology, Randers Regional Hospital, Randers, Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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Reszel J, Weiss D, Sprague AE, Fell DB, Dunn S, Walker MC, Sidney D, Taljaard M, Peterson WE. A mixed-methods evaluation of the MORE OB program in Ontario hospitals: participant knowledge, organizational culture, and experiences. BMC Health Serv Res 2019; 19:460. [PMID: 31286979 PMCID: PMC6615285 DOI: 10.1186/s12913-019-4224-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 06/06/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND MOREOB (Managing Obstetrical Risk Efficiently) is a patient safety program for health care providers and administrators in hospital obstetric units. MOREOB has been implemented widely in Canada and gradually spread to the United States. The main goal of MOREOB is to build a patient safety culture and improve clinical outcomes. In 2013, 26 Ontario hospitals voluntarily accepted provincial funding to participate in MOREOB. The purpose of our study was to assess the effect of MOREOB on participant knowledge, organizational culture, and experiences implementing and participating in the program at these 26 Ontario hospitals. METHODS A convergent parallel mixed-methods study in Ontario, Canada, with MOREOB participants from 26 hospitals. The quantitative component used a descriptive pre-post repeated measures design to assess participant knowledge and perception of culture, administered pre-MOREOB and after each of the three MOREOB modules. Changes in mean scores were assessed using mixed-effects regression. The qualitative component used a qualitative descriptive design with individual semi-structured interviews. We used content analysis to code, categorize, and thematically describe data. A convergent parallel design was used to triangulate findings from data sources. RESULTS 308 participants completed the knowledge test, and 329 completed the culture assessment at all four time points. Between baseline and post-Module 3, statistically significant increases on both scores were observed, with an increase of 7.9% (95% CI: 7.1 to 8.8) on the knowledge test and an increase of 0.45 (on a scale of 1-5, 95% CI: 0.38 to 0.52) on the culture assessment. Interview participants (n = 15) described improvements in knowledge, interprofessional communication, ability to provide safe care, and confidence in skills. Facilitators and barriers to program implementation and sustainability were identified. CONCLUSIONS Participants were satisfied with their participation in the MOREOB program and perceived that it increased health care provider knowledge and confidence, improved safety for patients, and improved communication between team members. Additionally, mean scores on knowledge tests for obstetric content and culture assessment improved. The MOREOB program can help organizations and individuals improve care by concentrating on the human and organizational aspects of patient safety. Further work to improve program implementation and sustainability is required.
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Affiliation(s)
- Jessica Reszel
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada
- Children’s Hospital of Eastern Ontario (CHEO) Research Institute, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada
| | - Deborah Weiss
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada
- School of Epidemiology and Public Health, University of Ottawa , 600 Peter Morand Crescent, Ottawa, Ontario K1G 5Z3 Canada
| | - Ann E. Sprague
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada
- Children’s Hospital of Eastern Ontario (CHEO) Research Institute, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada
| | - Deshayne B. Fell
- Children’s Hospital of Eastern Ontario (CHEO) Research Institute, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada
- School of Epidemiology and Public Health, University of Ottawa , 600 Peter Morand Crescent, Ottawa, Ontario K1G 5Z3 Canada
| | - Sandra Dunn
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada
- Children’s Hospital of Eastern Ontario (CHEO) Research Institute, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada
| | - Mark C. Walker
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada
- School of Epidemiology and Public Health, University of Ottawa , 600 Peter Morand Crescent, Ottawa, Ontario K1G 5Z3 Canada
- Clinical Epidemiology, Ottawa Hospital Research Institute (OHRI), 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
- Department of Obstetrics and Gynecology, University of Ottawa , 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
| | - Dana Sidney
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa , 600 Peter Morand Crescent, Ottawa, Ontario K1G 5Z3 Canada
- Clinical Epidemiology, Ottawa Hospital Research Institute (OHRI), 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
| | - Wendy E. Peterson
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5 Canada
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Abstract
Implementing change is difficult; few people want to wade into this area because of the challenge. However, it is highly rewarding and does not have to be complicated. Success requires a clear understanding of health care context, patient safety, and behavioral psychology. To achieve its goal, this article is divided into 3 parts: (1) the problem with engagement in health care, (2) patient safety in a new age, and (3) implementation.
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Affiliation(s)
- Paul James Armand Ruiter
- Salus Global, Knowledge Translation & Implementation Science Faculty, Canadian Patient Safety Institute, 200 - 717 Richmond Street, London, Ontario N6A 1S2, Canada.
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Weiss D, Fell DB, Sprague AE, Walker MC, Dunn S, Reszel J, Peterson WE, Coyle D, Taljaard M. Effect of implementation of the MORE OB program on adverse maternal and neonatal birth outcomes in Ontario, Canada: a retrospective cohort study. BMC Pregnancy Childbirth 2019; 19:151. [PMID: 31053113 PMCID: PMC6500060 DOI: 10.1186/s12884-019-2296-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 04/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background In 2002, the MOREOB (Managing Obstetrical Risk Efficiently) obstetrical patient safety program was phased-in across hospitals in Ontario, Canada. The purpose of our study was to evaluate the effect of the MOREOB program on rates of adverse maternal and neonatal outcomes. Methods A retrospective cohort study, using province-wide administrative hospitalization data. We included maternal and neonatal records between fiscal years 2002–2003 and 2013–2014, for deliveries taking place at the 67 Ontario hospitals where the MOREOB program was implemented between 2002 and 2012. After accounting for institutional mergers and excluding very small hospitals, 55 hospitals (1,447,073 deliveries) were included. Multivariable logistic and linear mixed effects regression analysis were used, accounting for secular trends, within hospital correlation and over time correlation, and adjusting for a maternal comorbidity index, hospital annual birth volume, and level of care. The main outcome measure was a composite individual-level indicator of incidence of any adverse events, and a hospital-level score, called the Weighted Adverse Outcome Score (WAOS) capturing both maternal and neonatal adverse outcomes. Results Across the 12 years of follow up, there were 98,789 adverse maternal and neonatal outcomes, a rate of 6.83 per 100 deliveries (6.66 per 100 occurring before, 6.91 per 100 during, and 6.84 per 100 after program implementation). The multivariable analysis found no statistically significant decrease in adverse events associated with program implementation (OR for adverse events after versus before =1.11 (95% CI: 1.06 to 1.17, change in mean WAOS score after minus before =0.15 (− 0.36 to 0.67)). Conclusions We did not find a reduction in the incidence of maternal and neonatal adverse outcomes associated with the MOREOB program, and small yet statistically significant increases in some adverse events were observed. Electronic supplementary material The online version of this article (10.1186/s12884-019-2296-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Deborah Weiss
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada. .,University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.
| | - Deshayne B Fell
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada.,University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Ann E Sprague
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada.,Children's Hospital of Eastern Ontario (CHEO) Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Mark C Walker
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada.,Ottawa Hospital Research Institute (OHRI), 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Sandra Dunn
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada.,Children's Hospital of Eastern Ontario (CHEO) Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Jessica Reszel
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada.,Children's Hospital of Eastern Ontario (CHEO) Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Wendy E Peterson
- University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada
| | - Doug Coyle
- University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Monica Taljaard
- University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.,OHRI, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada
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