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Weyers AR, von Waldenfels G, Gebert P, Henrich W, Hinkson L. Reducing trainee mistakes. Better performance with changing to a high-fidelity simulation system? AJOG GLOBAL REPORTS 2024; 4:100326. [PMID: 38524189 PMCID: PMC10958114 DOI: 10.1016/j.xagr.2024.100326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Postpartum hemorrhage is a significant cause of both maternal morbidity and mortality worldwide and is increasing in incidence. This study aimed to assess improvement and identify shortcomings in trainee performance in different simulation systems in the management of postpartum hemorrhage. OBJECTIVE To perform a pilot study evaluating and comparing high- and low-fidelity simulation models, assessing improvement in repeated performance with high-fidelity mode and identifying mistakes made assessed using Objective Structured Assessment of Technical Skills and thereby exploring what aspects of emergency management of postpartum hemorrhage should be prioritized in teaching settings and assessing what simulation setup is most effective in achieving competence. STUDY DESIGN This was a prospective randomized, single-blinded, single-institution trial in a population of 17 junior obstetrical trainees at the Charité University Hospital Obstetric Simulation Center in Berlin. Trainees were randomized into 2 groups, with either initial low-fidelity simulation or high-fidelity simulation, followed by repeated assessment of performance, using the high-fidelity model simulation system. Individual simulation sessions were video-recorded and transcribed, and the timing of interventions was documented. Strandardized Objective Structured Assessment of Technical Skills forms were used as a checklist for performance. RESULTS There was a statistically significant general improvement in performance (P=.02; 24.7-27.2 of 31.0 points; average of 8.7%) in the second cycle of simulation assessment and a statistically significant training effect (P=.043; 24.4-28.4 of 31.0 points; average of 12.9%) in the group that underwent repeat simulation assessment from the initial low-fidelity system to the high-fidelity system compared with the group using the same high-fidelity setup (P=.276; 25.0-25.8 of 31.0; average of 2.4%). CONCLUSION There was an improvement in the performance when trainees underwent a repeated cycle of simulation assessment changing from a low-fidelity system to a high-fidelity system. Simulation assessment can identify mistakes and learning gaps that are important for obstetrical trainees. This study found that trainees make the same mistakes, regardless of which simulation model was initially used.
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Affiliation(s)
- Aino Ritva Weyers
- Department of Obstetrics, Charité University Hospital, Berlin, Germany (Ms Weyers and Drs von Waldenfels, Henrich, and Hinkson)
- Department of Obstetrics and Gynecology, University of Bonn, Bonn, Germany (Ms Weyers)
| | - Gabriel von Waldenfels
- Department of Obstetrics, Charité University Hospital, Berlin, Germany (Ms Weyers and Drs von Waldenfels, Henrich, and Hinkson)
| | - Pimrapat Gebert
- Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Dr Gebert)
- Berlin Institute of Health, Berlin, Germany (Dr Gebert)
| | - Wolfgang Henrich
- Department of Obstetrics, Charité University Hospital, Berlin, Germany (Ms Weyers and Drs von Waldenfels, Henrich, and Hinkson)
| | - Larry Hinkson
- Department of Obstetrics, Charité University Hospital, Berlin, Germany (Ms Weyers and Drs von Waldenfels, Henrich, and Hinkson)
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Lee T, Yoon SW, Fernando S, Willey S, Kumar A. Blended (online and in-person) Women's Health Interprofessional Learning by Simulation (WHIPLS) for medical and midwifery students. Aust N Z J Obstet Gynaecol 2022; 62:596-604. [PMID: 35435241 PMCID: PMC9544949 DOI: 10.1111/ajo.13531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Blended teaching combines traditional in-person components (simulation-based training and clinical-based placement) with online resources. Due to the COVID-19 pandemic, we modified our Women's Health Interprofessional Learning through Simulation (WHIPLS) program - to develop core obstetric and gynaecological skills - into a blended teaching program. There is limited literature reporting the observations of blended teaching on learning. AIMS To qualitatively evaluate the blended teaching program and explore how it contributes to learning. MATERIALS AND METHODS This study was performed at Monash University in Melbourne, Australia. A total of 98 medical students and 39 midwifery students participated. Data were collected by written survey and analysed by authors using a thematic analysis framework. RESULTS Students reported that in-person teaching remains a vital aspect of their curriculum, contributing an averaged 63.2% toward an individual's learning, compared with online. Five substantial themes demonstrate how students learnt and maximised education opportunities using a blended teaching program: 'low-pressure simulation environments', 'peer-assisted learning', 'haptic learning', 'scaffolded learning' and 'the impact of online discourse'. DISCUSSION In-person teaching remains a cornerstone of obstetric and gynaecological clinical skills education, of which interprofessional simulation and clinical-based placement are key components. Teaching via online discourse alone, is not sufficient to completely replace and provide comparable learning outcomes, but certainly plays an important role to prime students' learning and to maximise in-person opportunities and resources. Our study reveals key pedagogies of a blended (online and in-person) learning program, providing further evidence to support its ongoing utility as a feasible and warranted approach to learning.
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Affiliation(s)
- Timothy Lee
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Si Woo Yoon
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Shavi Fernando
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Suzanne Willey
- Monash Nursing and Midwifery, Monash University, Frankston, Victoria, Australia
| | - Arunaz Kumar
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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Flentje M, Hagemann V, Brodowski L, Papageorgiou S, von Kaisenberg C, Eismann H. Influence of presence in an inter-professional simulation training of the emergency caesarean section: a cross-sectional questionnaire study. Arch Gynecol Obstet 2022; 305:1499-1505. [PMID: 35218367 PMCID: PMC9166820 DOI: 10.1007/s00404-022-06465-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 02/15/2022] [Indexed: 11/29/2022]
Abstract
Purpose Emergency training using simulation is a method to increase patient safety in the delivery room. The effect of individual training concepts is critically discussed and requires evaluation. A possible influence factor of success can be the perceived reality of the participants. The objective of this study was to investigate whether the presence in a simulated emergency caesarean section improves subjective effect of the training and evaluation. Methods In this observation study, professionals took part in simulated emergency caesarean sections to improve workflow and non-technical skills. Presence was measured by means of a validated questionnaire, effects and evaluation by means of a newly created questionnaire directly after the training. Primary outcome was a correlation between presence and assumed effect of training and evaluation. Results 106 participants (70% of course participants) answered the questionnaires. Reliability of the presence scale was good (Cronbach’s alpha 0.72). The presence correlated significantly with all evaluated items of non-technical skills and evaluation of the course. The factor “mutual support” showed a high effect size (0.639), the overall evaluation of the course (0.395) and the willingness to participate again (0.350) a medium effect. There were no differences between the professional groups. Conclusion The presence correlates with the assumed training objectives and evaluation of the course. If training is not successful, it is one factor that needs to be improved.
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Affiliation(s)
- Markus Flentje
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Vera Hagemann
- Faculty of Business Studies and Economics, Business Psychology, University of Bremen, Enrique-Schmidt-Strasse 1, 28359, Bremen, Germany
| | - Lars Brodowski
- Department of Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Spiyridon Papageorgiou
- Department of Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Constantin von Kaisenberg
- Department of Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Hendrik Eismann
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
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Perry JD, Maples JM, Deisher HN, Trimble H, van Nes JV, Morton K, Zite NB. A Novel Approach to Teaching the Cervical Exam: A Versatile, Low-Cost Simulation for Labor and Delivery Learners. Cureus 2021; 13:e20235. [PMID: 35004050 PMCID: PMC8730796 DOI: 10.7759/cureus.20235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 11/05/2022] Open
Abstract
This technical report describes the making of cervical exam models that can be used to teach cervical dilation and effacement, with the versatility to teach additional obstetrical skills including artificial rupture of membranes (AROM) and fetal scalp electrode (FSE) placement. These models, primarily constructed from materials that are low cost and/or easily accessible within a healthcare setting, can be used to educate nurses, medical students, residents, and other healthcare professionals to improve the evaluation of the labor progress.
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Affiliation(s)
- Jamie D Perry
- Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, USA
| | - Jill M Maples
- Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, USA
| | - Heather N Deisher
- Brookwood Women's Health PC, Brookwood Baptist Medical Center, Birmingham, USA
| | - Hayley Trimble
- Obstetrics and Gynecology, Pikeville Medical Center, Pikeville, USA
| | - Jaclyn V van Nes
- Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, USA
| | - Kaitlin Morton
- Kinesiology, Recreation, and Sport, University of Tennessee, Knoxville, USA
| | - Nikki B Zite
- Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, USA
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Cooper S, Cant R, Chung C. The Impact of Emerging Simulation-Based Technologies on the Management of Deteriorating Patients: Aiming for a Gold Standard Educational Evaluation. Clin Simul Nurs 2020. [DOI: 10.1016/j.ecns.2020.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Winter JD, Adleman J, Purdie TG, Heaton J, McNiven A, Croke J. An Innovative Learning Tool for Radiation Therapy Treatment Plan Evaluation: Implementation and Evaluation. Int J Radiat Oncol Biol Phys 2020; 107:844-849. [PMID: 32259570 DOI: 10.1016/j.ijrobp.2020.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/28/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To design, develop, and evaluate an interactive simulation-based learning tool for treatment plan evaluation for radiation oncology and medical physics residents to address gaps in learning. METHODS AND MATERIALS We first conducted a needs assessment for optimal learning tool design and case selection. Next, we generated a curated database of cases with clinically unacceptable treatment plans accessible through an in-house developed interactive web-based digital imaging and communications in medicine-radiation therapy viewer. We then developed an interactive user module that allows case selection, learner participation, and immediate feedback, including the final clinically acceptable plan. We pilot tested this case bank learning tool with current radiation oncology and medical physics residents within our institution. Afterward, residents completed an evaluation of tool design, content, and perceived impact on learning and provided suggestions for improvement. RESULTS We generated 70 cases and learning modules for the case bank, encompassing various clinical sites, levels of difficulty, and classified errors. Residents positively endorsed the learning tool, including design, content, and perceived impact on learning. The learning tool's interactivity was perceived to provide increased educational value compared with other current learning methods. CONCLUSIONS We created a high-fidelity simulation platform for treatment plan evaluation linked to a curated case bank. Evaluation of the pilot deployment demonstrated a benefit for resident learning and competency attainment. Future directions include external validation and expansion.
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Affiliation(s)
- Jeff D Winter
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jenna Adleman
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Thomas G Purdie
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | | | - Andrea McNiven
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Croke
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
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DeStephano CC, Nitsche JF, Heckman MG, Banks E, Hur HC. ACOG Simulation Working Group: A Needs Assessment of Simulation Training in OB/GYN Residencies and Recommendations for Future Research. JOURNAL OF SURGICAL EDUCATION 2020; 77:661-670. [PMID: 31859227 DOI: 10.1016/j.jsurg.2019.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/29/2019] [Accepted: 12/01/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate current availability and needs of simulation training among obstetrics/gynecology (OB/GYN) residency programs. DESIGN Cross-sectional survey. SETTING Accreditation Council for Graduate Medical Education accredited OB/GYN residency programs in the United States. PARTICIPANTS Residency program directors, gynecology simulation faculty, obstetrics simulation faculty, and fourth-year residents. RESULTS Of 673 invited participants, 251 (37.3%) completed the survey. Among the survey responses, OB procedures were more broadly represented compared to the GYN procedures for simulation teaching: 8 (50%) of 16 OB procedures versus 4 (18.2%) of 22 GYN procedures had simulation teaching. Among the simulated procedures, a majority of residents and faculty reported that simulation teaching was available for operative vaginal delivery, postpartum hemorrhage, shoulder dystocia, perineal laceration repair, conventional laparoscopic procedures, and robotic surgery. There were significant differences between residents and faculty perceptions regarding the availability and needs of simulated procedures with a minority of residents having knowledge of Council on Resident Education in Obstetrics and Gynecology (47.2%) and American College of Obstetrics and Gynecology (27.8%) simulation tools compared to the majority of faculty (84.7% and 72.1%, respectively). More than 80% of trainees and faculty reported they felt the average graduating resident could perform vaginal, laparoscopic, and abdominal hysterectomies independently. CONCLUSIONS Simulation is now widely available for both gynecologic and obstetric procedures, but there remains tremendous heterogeneity between programs and the perceptions of residents, program directors, and faculty. The variations in simulation training and readiness for performing different procedures following residency support the need for objective, validated assessments of actual performance to better guide resident learning and faculty teaching efforts.
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Affiliation(s)
| | - Joshua F Nitsche
- Wake Forest School of Medicine Department of OB/GYN, Winston-Salem, North Carolina
| | - Michael G Heckman
- Mayo Clinic Department of Surgical Gynecology, Jacksonville, Florida; Mayo Clinic Division of Biomedical Statistics and Informatics, Jacksonville, Florida
| | - Erika Banks
- Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, New York, New York
| | - Hye-Chun Hur
- Division of Gynecologic Specialty Surgery, Department of Obstetrics and Gynecology, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York
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Sok SR, Kim JA, Lee Y, Cho Y. Effects of a Simulation-Based CPR Training Program on Knowledge, Performance, and Stress in Clinical Nurses. J Contin Educ Nurs 2020; 51:225-232. [PMID: 32347959 DOI: 10.3928/00220124-20200415-07] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 11/04/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Rapid and accurate cardiopulmonary resuscitation (CPR) performed by clinical nurses plays an important role in increasing the survival rate of cardiac arrest patients in the hospital. PURPOSE This study examined the effects of a simulation-based CPR training program on knowledge, performance, and stress of CPR in clinical nurses. METHOD A quasi-experimental pretest-posttest control group design was used. Study participants included 60 clinical nurses (experimental group, n = 30, and control group, n = 30) in a general hospital in Seoul, South Korea. A 4-hour simulation-based CPR training program was conducted. Measures included the knowledge scale and performance scale from the Korean Association of Cardiopulmonary Resuscitation and the Post Code Stress Scale in Korean. RESULTS The simulation-based CPR training program significantly improved CPR knowledge (t = 4.664, p < .001) and performance (t = 4.940, p < .001), and decreased stress (t = -5.832, p < .001) in clinical nurses. CONCLUSION These findings indicate a simulation-based CPR training program was effective in improving knowledge and performing CPR, as well as in decreasing stress of CPR in clinical nurses. [J Contin Educ Nurs. 2020;51(5):225-232.].
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Nayahangan LJ, Konge L, Møller-Skuldbøl IM, Kolster D, Paltved C, Sørensen JL. A Nationwide Needs Assessment to Identify and Prioritize Technical Procedures for Simulation in Obstetrics and Gynaecology: A Delphi Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:409-419. [PMID: 31859204 DOI: 10.1016/j.jogc.2019.08.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aims of the study were to identify and prioritize technical procedures that should be developed and integrated in a simulation-based curriculum for obstetrics and gynaecology residents. METHODS The Delphi method was used, consisting of three rounds of survey questionnaires. Key leaders across Denmark were invited to participate. In Delphi round 1, the participants individually identified technical procedures that newly authorized specialists should be able to perform. These procedures were sent to round 2 to be explored for need for simulation-based training by estimating frequency of procedures, number of doctors, potential patient risk and/or discomfort, and feasibility of simulation. Round 3 consisted of elimination and prioritization of remaining procedures (Canadian Task Force Classification III). RESULTS A total of 165 key leaders were invited. Response rates were 61%, 50%, and 53%, respectively. Identified procedures in Round 1 were as follows: gynaecology (n = 51), obstetrics (n = 40), and general procedures (n = 10). A needs assessment formula was used to calculate needs for training on the basis of the answers in round 2 and produce a preliminary prioritized list that was sent to round 3 for final exploration. Round 3 consisted of elimination and final prioritization, where gynaecology (n = 17) prioritized basic laparoscopy, vaginal ultrasound, and laparoscopy with salpingostomy and salpingectomy; obstetrics procedures (n = 16) prioritized basic resuscitation of newborn, vacuum extraction, and management of shoulder dystocia; and one general procedure (basic adult resuscitation) was included. CONCLUSION A needs assessment using the Delphi method produced a prioritized list of technical procedures suitable for simulation. This can guide the development of simulation-based training programs.
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Affiliation(s)
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Dorthe Kolster
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Charlotte Paltved
- MidtSim - Centre for Human Resources, Central Region of Denmark and Aarhus University, Aarhus, Denmark
| | - Jette Led Sørensen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Juliane Marie Center for Children, Women, and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Ceccaldi PF, Pirtea P, Lemarteleur V, Poulain M, Ziegler DD, Ayoubi JM. Simulation and professional development: added value of 3D modelization in reproductive endocrinology and infertility and assisted reproductive technologies teamwork. Gynecol Endocrinol 2019; 35:559-563. [PMID: 30935263 DOI: 10.1080/09513590.2019.1588874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
As in other specialties of medicine, there is more to clinical performance in reproductive endocrinology, infertility, and assisted reproductive technologies (REI-ART) than simply the individual knowledge and technical skills. Simulation is commonly used during fellowship training in REI-ART, aiming to produce a virtual cycle of professional development in order to improve patient outcome. With scientific certification and the joint development of evaluation tools, the contribution of digitalization, such as 3 D printing and digital simulators, will facilitate teamwork in REI-ART and enable a better transmission of knowledge in the specialty.
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Affiliation(s)
- Pierre-François Ceccaldi
- a Simulation Department of Paris Diderot University , ILumens Paris Diderot, Paris , France
- b Obstetrics and Gynecology Department , Beaujon Teaching Hospital, Assistance Publique Hôpitaux de Paris , Paris , France
| | - Paul Pirtea
- c Department of Obstetrics, Gynecology, and Reproductive Medicine , Hôpital Foch, Faculté de Médecine Paris Ouest, (UVSQ) , Suresnes , France
| | - Vincent Lemarteleur
- a Simulation Department of Paris Diderot University , ILumens Paris Diderot, Paris , France
| | - Marine Poulain
- c Department of Obstetrics, Gynecology, and Reproductive Medicine , Hôpital Foch, Faculté de Médecine Paris Ouest, (UVSQ) , Suresnes , France
| | - Dominique De Ziegler
- c Department of Obstetrics, Gynecology, and Reproductive Medicine , Hôpital Foch, Faculté de Médecine Paris Ouest, (UVSQ) , Suresnes , France
| | - Jean-Marc Ayoubi
- c Department of Obstetrics, Gynecology, and Reproductive Medicine , Hôpital Foch, Faculté de Médecine Paris Ouest, (UVSQ) , Suresnes , France
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Campbell KH, Illuzzi JL, Lee HC, Lin H, Lipkind HS, Lundsberg LS, Pettker CM, Xu X. Optimal maternal and neonatal outcomes and associated hospital characteristics. Birth 2019; 46:289-299. [PMID: 30251270 DOI: 10.1111/birt.12400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aims to examine hospital variation in both maternal and neonatal morbidities and identify institutional characteristics associated with hospital performance in a combined measure of maternal and neonatal outcomes. METHODS Using the California Linked Birth File containing data from birth certificate and hospital discharge records, we identified 1 322 713 term births delivered at 248 hospitals during 2010-2012. For each hospital, a risk-standardized rate of severe maternal morbidities and a risk-standardized rate of severe newborn morbidities were calculated after adjusting for patient clinical risk factors. Hospitals were ranked based on combined information on their maternal and newborn morbidity rates. RESULTS Risk-standardized severe maternal and severe newborn morbidity rates varied substantially across hospitals (10th to 90th percentile range = 67.5-148.2 and 141.8-508.0 per 10 000 term births, respectively), although there was no significant association between the two (P = 0.15). Government hospitals (non-Federal) were more likely than other hospitals to be in worse rank quartiles (P value for trend = 0.004), whereas larger volume was associated with better rank among hospitals in the first three quartiles (P = 0.004). The most prevalent morbidities that differed progressively across hospital rank quartiles were severe hemorrhage, disseminated intravascular coagulation, and heart failure during procedure/surgery for mothers, and severe infection, respiratory complication, and shock/resuscitation for neonates. CONCLUSIONS Hospitals with low maternal morbidity rates may not have low neonatal morbidity rates and vice versa, highlighting the importance of assessing joint maternal-newborn outcomes in order to fully characterize a hospital's obstetrical performance. Hospitals with smaller volume and government ownership tend to have less desirable outcomes and warrant additional attention in future quality improvement efforts.
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Affiliation(s)
- Katherine H Campbell
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Jessica L Illuzzi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Henry C Lee
- Department of Pediatrics, Division of Neonatal & Developmental Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Haiqun Lin
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Heather S Lipkind
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Lisbet S Lundsberg
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Christian M Pettker
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Xiao Xu
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
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Shivraj P, Novak A, Aziz S, Larsen W, Ramin S. The Certification Process Driving Patient Safety. Obstet Gynecol Clin North Am 2019; 46:269-280. [DOI: 10.1016/j.ogc.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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