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Ragbourne SC, Charles E, Herincs M, Desai N. Anaesthetic considerations for impacted fetal head at caesarean delivery: a focused review. Int J Obstet Anesth 2024; 61:104268. [PMID: 39342879 DOI: 10.1016/j.ijoa.2024.104268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 09/10/2024] [Accepted: 09/12/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND Impacted fetal head occurs when the fetal head is deeply engaged within the maternal pelvis and difficult to deliver during caesarean delivery. In order to deliver the fetal head, additional surgical manoeuvres and/or pharmacological tocolysis are needed. The aim of this focused review is to outline the incidence, risk factors, management and complications of this obstetric emergency from the perspective of the anaesthetist. METHODS Databases were searched for free text headings and subject headings associated with different permutations of terms related to impacted fetal head and caesarean delivery. RESULTS Impacted fetal head has been estimated to occur in 1.5 % of elective caesarean deliveries and 2.9-18.4% of all emergency caesarean deliveries at any cervical dilatation. Risk factors include advanced cervical dilatation, labour augmentation with oxytocin, prolonged second stage of labour, fetal malposition and junior grade of operating obstetrician. If impacted fetal head occurs, the anaesthetist in conjunction with the multidisciplinary team should consider decreasing the height of the operating table, providing a step for the obstetrician to stand on, placing the patient in the head down position, providing pharmacological tocolysis with glyceryl trinitrate (or nitroglycerin), beta-2 adrenoreceptor agonists or volatile anaesthetic agents, and managing complications such as postpartum haemorrhage. CONCLUSION Impacted fetal head is an obstetric emergency that the anaesthetist should be familiar with and has a vital role in managing. We propose an algorithm for management that may serve as a clinical decision aid.
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Affiliation(s)
- S C Ragbourne
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - E Charles
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - M Herincs
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - N Desai
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Honorary Senior Clinical Lecturer, King's College London, London, United Kingdom.
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Ragbourne SC, Charles E, Herincs M, Elwen F, Desai N. Impacted fetal head at cesarean delivery. J Clin Anesth 2024; 99:111598. [PMID: 39276524 DOI: 10.1016/j.jclinane.2024.111598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 08/08/2024] [Accepted: 09/02/2024] [Indexed: 09/17/2024]
Abstract
PURPOSE Impacted fetal head (IFH) can be defined as the deep engagement of the fetal head in the maternal pelvis at the time of cesarean delivery that leads to its difficult or impossible extraction with standard surgical maneuvers. In this narrative review, we aimed to ascertain its incidence, risk factors, management and complications from the perspective of the anesthesiologist as a multidisciplinary team member. METHODS Databases were searched from inception to 24 January 2023 for keywords and subject headings associated with IFH and cesarean delivery. RESULTS IFH has an incidence of 2.9-71.8 % in emergency cesarean section. Maternal risk factors are advanced cervical dilatation, second stage of labor and oxytocin augmentation. Anesthetic and obstetric risk factors include epidural analgesia and trial of instrumental delivery and junior obstetrician, respectively. Neonatal risk factors are fetal malposition, caput and molding. Current evidence indicates a lack of confidence in the management of IFH across the multidisciplinary team. Simple interventions in IFH include lowering the height or placing the operating table in the Trendelenburg position, providing a step for the obstetrician and administering pharmacological tocolysis. Maternal complications are postpartum hemorrhage and bladder injury while neonatal complications include hypoxic brain injury, skull fracture and death. Surgical complications are reviewed to remind the anesthesiologist to anticipate and prepare for potential problems and manage complications in a timely manner. CONCLUSION The anesthesiologist has a fundamental role in the facilitation of delivery in IFH. We have proposed an evidence based management algorithm which may be referred to in this emergency situation.
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Affiliation(s)
- Sophie C Ragbourne
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Elinor Charles
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Maria Herincs
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Francesca Elwen
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Neel Desai
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Honorary Senior Clinical Lecturer, King's College London, London, United Kingdom.
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Brogaard L, Rosvig L, Hjorth-Hansen KR, Hvidman L, Hinshaw K, Kierkegaard O, Uldbjerg N, Manser T. Team performance during vacuum-assisted vaginal delivery: video review of obstetric multidisciplinary teams. Front Med (Lausanne) 2024; 11:1330457. [PMID: 38572162 PMCID: PMC10987771 DOI: 10.3389/fmed.2024.1330457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/12/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction Vacuum extraction is generally considered an operator-dependent task, with most attention directed toward the obstetrician's technical abilities (1-3). Little is known about the effect of the team and non-technical skills on clinical outcomes in vacuum-assisted delivery. This study aimed to investigate whether the non-technical skills of obstetricians were correlated with their level of clinical performance via the analysis of video recordings of teams conducting actual vacuum extractions. Methods We installed between two or three video cameras in each delivery room at Aarhus University Hospital and Horsens Regional Hospital and obtained 60 videos of teams managing vacuum extraction. Appropriate consent was obtained. Two raters carefully reviewed the videos and assessed the teams' non-technical skills using the Assessment of Obstetric Team Performance (AOTP) checklist, rating all items on a Likert scale score from 1 to 5 (1 = poor; 3 = average; and 5 = excellent). This resulted in a total score ranging from 18 to 90. Two different raters independently assessed the teams' clinical performance (adherence to clinical guidelines) using the TeamOBS-Vacuum-Assisted Delivery (VAD) checklist, rating each item (0 = not done, 1 = done incorrectly; and 2 = done correctly). This resulted in a total score with the following ranges (low clinical performance: 0-59; average: 60-84; and high: 85-100). Interrater agreement was analyzed using intraclass correlation (ICC), and the risk of high or low clinical performance was analyzed on a logit scale to meet the assumption of normality. Results Teams that received excellent non-technical scores had an 81% probability of achieving high clinical performance, whereas this probability was only 12% among teams with average non-technical scores (p < 0.001). Teams with a high clinical performance often had excellent behavior in the non-technical items of "team interaction," "anticipation," "avoidance fixation," and "focused communication." Teams with a low or average clinical performance often neglected to consider analgesia, had delayed abandonment of the attempted vaginal delivery and insufficient use of appropriate fetal monitoring. Interrater reliability was high for both rater-teams, with an ICC for the non-technical skills of 0.83 (95% confidence interval [CI]: 0.71-0.88) and 0.84 for the clinical performance (95% CI: 0.74-0.90). Conclusion Although assisted vaginal delivery by vacuum extraction is generally considered to be an operator-dependent task, our findings suggest that teamwork and effective team interaction play crucial roles in achieving high clinical performance. Teamwork helped the consultant anticipate the next step, avoid fixation, ensure adequate analgesia, and maintain thorough fetal monitoring during delivery.
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Affiliation(s)
- L. Brogaard
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - L. Rosvig
- Department of Obstetrics and Gynecology, Randers Hospital, Randers, Denmark
| | | | - L. Hvidman
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - K. Hinshaw
- Department of Obstetrics and Gynecology, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - O. Kierkegaard
- Department of Obstetrics and Gynecology, Horsens Regional Hospital, Horsens, Denmark
| | - N. Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - T. Manser
- FHNW School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
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4
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Hughes AM, Arredondo K, Lester HF, Oswald FL, Pham TND, Jiang C, Hysong SJ. What can we learn from COVID-19?: examining the resilience of primary care teams. Front Psychol 2023; 14:1265529. [PMID: 38078279 PMCID: PMC10703302 DOI: 10.3389/fpsyg.2023.1265529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/06/2023] [Indexed: 02/12/2024] Open
Abstract
Introduction The COVID-19 pandemic continues to place an unprecedented strain on the US healthcare system, and primary care is no exception. Primary care services have shifted toward a team-based approach for delivering care in the last decade. COVID-19 placed extraordinary stress on primary care teams at the forefront of the pandemic response efforts. The current work applies the science of effective teams to examine the impact of COVID-19-a crisis or adverse event-on primary care team resilience. Methods Little empirical research has been done testing the theory of team resilience during an extremely adverse crisis event in an applied team setting. Therefore, we conducted an archival study by using large-scale national data from the Veterans Health Administration to understand the characteristics and performance of 7,023 Patient Aligned Care Teams (PACTs) during COVID-19. Results Our study found that primary care teams maintained performance in the presence of adversity, indicating possible team resilience. Further, team coordination positively predicted team performance (B = 0.53) regardless of the level of adversity a team was experiencing. Discussion These findings in turn attest to the need to preserve team coordination in the presence of adversity. Results carry implications for creating opportunities for teams to learn and adjust to an adverse event to maintain performance and optimize team-member well-being. Teamwork can act as a protective factor against high levels of workload, burnout, and turnover, and should be studied further for its role in promoting team resilience.
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Affiliation(s)
- Ashley M. Hughes
- Department of Biostatistics and Epidemiology, University of Illinois at Chicago, Chicago, IL, United States
- Center of VHA Innovation for Complex, Chronic Healthcare, Edward Hines JR VA Hospital, Hines, IL, United States
| | - Kelley Arredondo
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States
- Veterans’ Health Administration Office of Rural Health’s Veterans Center, White River Junction, VT, United States
- VA South Central Mental Illness Research, Education and Clinical Center (SC MIRECC), a Virtual Center, Houston, TX, United States
| | - Houston F. Lester
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Department of Management, University of Mississippi, Oxford, MS, United States
| | - Frederick L. Oswald
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Trang N. D. Pham
- Department of Biostatistics and Epidemiology, University of Illinois at Chicago, Chicago, IL, United States
| | - Cheng Jiang
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Sylvia J. Hysong
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States
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Schwindenhammer V, Rimmelé T, Duclos A, Haesebaert J, Lilot M, Abraham P. A new standardized tool for quantification of closed-loop communication in trauma care: CAST Grid reliability study. Injury 2023; 54:110851. [PMID: 37336655 DOI: 10.1016/j.injury.2023.110851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/11/2023] [Accepted: 05/26/2023] [Indexed: 06/21/2023]
Abstract
BACKROUND The CAST Grid has been developed to evaluate the use of closed-loop communication (CLC) in the trauma bay. METHODS The CAST Grid and two validated non-technical team performance assessment tools (the TEAM and T-NOTECHS grids) were completed by 2 independent reviewers based on trauma care simulation videos from a French Level 1 trauma center. Intra- and inter-rater agreements were evaluated for CLC parameters and non-technical performance, and correlations between these parameters were analyzed. RESULTS The study analyzed 11 videos. The intra- and inter-rater agreement for the number of CLC per minute (CLC/min) was moderate and good, respectively, based on Lin's concordance correlation coefficient [95%CI] (0.57 [-0.40;0.94] and 0.77 [0.33;0.94]). However, the agreement was poor for the percentage of CLC (0.37 [-0.58;0.89] and -0.36 [-0.71;0.14], respectively). The study found that a lower number of CLC/min was correlated with an increased duration of the simulation (r = -0.75 [-0.93; -0.25]). CONCLUSION The CAST Grid showed a relatively good inter-rater agreement to quantify the number of CLC/min which was inversely correlated with the duration of care. This tool opens up the possibility of quantifying CLC and allows for new analyses of team functioning and interactions.
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Affiliation(s)
- Victor Schwindenhammer
- Pôle Anesthésie-Réanimation, Centre Hospitalier Universitaire Grenoble - Alpes, La Tronche, France; Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), Lyon, France.
| | - Thomas Rimmelé
- Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), Lyon, France; EA 7426, PI3 (Pathophysiology of Injury-Induced Immunosuppression), Claude Bernard University Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France; Service d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Antoine Duclos
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Lyon 1, CEDEX 08, F-69373 Lyon, France
| | - Julie Haesebaert
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Lyon 1, CEDEX 08, F-69373 Lyon, France; Pôle Santé Publique, Service d'épidémiologie et de recherche clinique, F-69003, Hospices Civils de Lyon, Lyon, France
| | - Marc Lilot
- Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), Lyon, France; Research on Healthcare Performance RESHAPE, INSERM U1290, Université Lyon 1, CEDEX 08, F-69373 Lyon, France; Hospices Civils de Lyon, Department of paediatric cardio-thoracic anesthesia and intensive care, Louis Pradel Hospital, Lyon, France
| | - Paul Abraham
- Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), Lyon, France; Service d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Service de Médecine Intensive Adulte, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Suisse
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Feltmate C, Easter SR, Gilner JB, Karam AK, Khourry-Callado F, Fox KA. Graduate and Continuing Medical Education of Placenta Accreta Spectrum. Am J Perinatol 2023; 40:1002-1008. [PMID: 37336218 DOI: 10.1055/s-0043-1761640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Surgical training experience in obstetrics-gynecology (OB-GYN) residency and fellowship training, particularly in open abdominal surgeries has declined over the last 2 decades. This is due, in part, due to a universal trend toward non-invasive treatments for gynecologic conditions once treated surgically. Management of placenta accreta spectrum (PAS) often requires complex surgical skills, including, but not limited to highly complex hysterectomy. The decline in surgical case numbers has fallen as the incidence of PAS has risen, which we anticipate will lead to a gap in critical skills needed for graduating obstetrician-gynecologists to able to safely care for people with PAS.
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Affiliation(s)
- Colleen Feltmate
- Division of Gynecologic Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, Massachusetts
| | - Sarah R Easter
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jennifer B Gilner
- Division of Maternal-Fetal Medicine, Duke University Medical Center, Durham, North Carolina
| | - Amer K Karam
- Division of Gynecologic Oncology, Stanford University, Palo Alto, California
| | - Fady Khourry-Callado
- Division of Gynecologic Oncology, Columbia University, Herbert Irving Comprehensive Cancer Center, New York, New York
| | - Karin A Fox
- Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, Texas
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Closed-Loop Communication in Interprofessional Emergency Teams: A Cross-Sectional Observation Study on the Use of Closed-Loop Communication Among Anesthesia Personnel. J Patient Saf 2023; 19:93-98. [PMID: 36729479 DOI: 10.1097/pts.0000000000001098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Communication failure is one of the most common causes of adverse events in hospitals and poses a direct threat to patient safety. Research recommends the use of closed-loop communication in interprofessional emergency teams to prevent such events. Multiple studies have examined closed-loop communication during simulation training, but few have investigated its use in clinical practice. The aim of the study was to explore the use of closed-loop communication by anesthesia personnel in real-life interprofessional emergency teams. METHODS This study had a descriptive, cross-sectional design where structured field observations were used to assess anesthesia personnel's use of closed-loop communication in real-life interprofessional emergency teams. A total of 60 interprofessional teams were observed, including 120 anesthesia personnel at a hospital in South-Eastern Norway. Data were analyzed using descriptive statistics. RESULTS A total of 1626 call outs were registered, in which closed-loop communication was applied in 45%. Closed-loop communication was used more frequently when call outs were directed using eye contact and when the call outs were medication orders. There was no difference in the use of closed-loop communication between nurse anesthetists and anesthesiologists. Closed-loop communication was used more frequently in cardiac arrest teams than in trauma teams. CONCLUSIONS The findings in this study have contributed knowledge about anesthesia personnel's use of closed-loop communication in real-life interprofessional emergency teams and indicate a potential for improvement. Further research is needed about real-life interprofessional emergency teams' communication patterns and potential barriers from using closed-loop communication, with the aim to improve patient safety.
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Hamberger M, Ikonomi N, Schwab JD, Werle SD, Fürstberger A, Kestler AM, Holderried M, Kaisers UX, Steger F, Kestler HA. Interaction Empowerment in Mobile Health: Concepts, Challenges, and Perspectives. JMIR Mhealth Uhealth 2022; 10:e32696. [PMID: 35416786 PMCID: PMC9047725 DOI: 10.2196/32696] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/13/2021] [Accepted: 02/20/2022] [Indexed: 12/25/2022] Open
Abstract
In its most trending interpretation, empowerment in health care is implemented as a patient-centered approach. In the same sense, many mobile health (mHealth) apps are being developed with a primary focus on the individual user. The integration of mHealth apps into the health care system has the potential to counteract existing challenges, including incomplete or nonstandardized medical data and lack of communication, especially in the intersectional context (eg, patients, medical forces). However, concerns about data security and privacy, regional differences in regulations, lack of accessibility, and nontransparent apps hinder the successful integration of mHealth into the health care system. One approach to address this is to rethink the interpretation of empowerment. On that basis, we here examine existing approaches of individual empowerment and subsequently analyze a different view of empowerment in digital health, namely interaction empowerment. Such a change of perspective could positively influence intersectoral communication and facilitate secure data and knowledge sharing. We discuss this novel viewpoint on empowerment, focusing on more efficient integration and development of mHealth approaches. A renewed interpretation of empowerment could thus buffer current limitations of individual empowerment while also advancing digitization of the health system.
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Affiliation(s)
| | - Nensi Ikonomi
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
| | - Julian D Schwab
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
| | - Silke D Werle
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
| | - Axel Fürstberger
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
| | | | - Martin Holderried
- Department of Medical Development and Quality Management, University Hospital Tübingen, Tübingen, Germany
| | - Udo X Kaisers
- Chief Executive Officer, University Hospital Ulm, Ulm, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
| | - Hans A Kestler
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
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Topperzer MK, Roug LI, Andrés-Jensen L, Pontoppidan P, Hoffmann M, Larsen HB, Schmiegelow K, Sørensen JL. Twelve tips for postgraduate interprofessional case-based learning. MEDICAL TEACHER 2022; 44:130-137. [PMID: 33761309 DOI: 10.1080/0142159x.2021.1896691] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Based on developing, implementing, and evaluating postgraduate interprofessional case-based learning, we have written these twelve tips for health education planners who wish to apply case-based learning in the clinical setting. Interprofessional case-based learning engages participants in a structured manner towards uncovering decisions processes and patterns of action that resemble the clinical reality in which various healthcare professionals handle multifaceted tasks related to the optimal patient treatment. Postgraduate interprofessional case-based learning has the potential to break down traditional hierarchical structures as interactions generate respectful behaviour. We present two models of case-based learning to assist in standardising, structuring, and systematising postgraduate interprofessional case-based learning. We have created 12 practical tips for the design, implementation, and evaluation of successful postgraduate interprofessional case-based learning integrated into the existing clinical setting.
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Affiliation(s)
- Martha Krogh Topperzer
- Department of Paediatrics and Adolescent Medicine, Paediatric Oncology Research Laboratory, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Louise Ingerslev Roug
- Department of Paediatrics and Adolescent Medicine, Paediatric Oncology Research Laboratory, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Liv Andrés-Jensen
- Department of Paediatrics and Adolescent Medicine, Paediatric Oncology Research Laboratory, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter Pontoppidan
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Hoffmann
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Baekgaard Larsen
- Department of Paediatrics and Adolescent Medicine, Paediatric Oncology Research Laboratory, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, Paediatric Oncology Research Laboratory, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jette Led Sørensen
- Department of Clinical Medicine, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Angouri J, Mesinioti P, Siassakos D. Let’s talk about it: reframing communication in medical teams. Best Pract Res Clin Obstet Gynaecol 2022; 80:75-91. [DOI: 10.1016/j.bpobgyn.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/06/2022] [Accepted: 01/13/2022] [Indexed: 11/30/2022]
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Reassuringly expensive - A commentary on obstetric emergency training in high-resource settings. Best Pract Res Clin Obstet Gynaecol 2021; 80:14-24. [PMID: 34893439 DOI: 10.1016/j.bpobgyn.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 11/22/2022]
Abstract
The pathophysiologic origins of obstetrical emergencies are complicated and may well be influenced by events prior to conception. Such problems are not likely to be resolved soon, and in the meantime, high-resource countries simply cannot afford to divert more and more money to litigation and the costs of preventable morbidities for either mother or child. It is long past time we tackled these acute care problems where most first occur-the Maternity unit. It is reasonable to ask whether hospitals (and society at large) are getting what they believe they are buying. Training to satisfy a regulation without improving patient outcomes functionally erects one more barrier to the pursuit of optimal patient outcomes. Why then continue squandering limited resources and precious lives if current hospital training is not improving outcomes? In this monograph, I focus on training programs for the management of obstetrical emergencies.
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12
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Jaufuraully S, Dromey B, Stoyanov D. Simulation and beyond - Principles of effective obstetric training. Best Pract Res Clin Obstet Gynaecol 2021; 80:2-13. [PMID: 34866004 DOI: 10.1016/j.bpobgyn.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 11/15/2022]
Abstract
Simulation training provides a safe, non-judgmental environment where members of the multi-professional team can practice both their technical and non-technical skills. Poor teamwork and communication are recurring contributing factors to adverse maternal and neonatal outcomes. Simulation can improve outcomes and is now a compulsory part of the national training matrix. Components of successful training include involving the multi-professional team, high fidelity models, keeping training on-site, and focussing on human factors training; a key factor in adverse patient outcomes. The future of simulation training is an exciting field, with the advent of augmented reality devices and the use of artificial intelligence.
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Affiliation(s)
- Shireen Jaufuraully
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK; Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK.
| | - Brian Dromey
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK; Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
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13
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Dillon S. Simulation in Obstetrics and Gynecology: A Review of the Past, Present, and Future. Obstet Gynecol Clin North Am 2021; 48:689-703. [PMID: 34756290 DOI: 10.1016/j.ogc.2021.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Simulation in obstetrics and gynecology has advanced significantly since its beginnings in the seventeenth century with wooden birthing and pelvic models. In recent years, more and more evidence has emerged showing improvements in participant confidence, skills, behaviors, and, finally, patient outcomes following simulation program implementation. Several regulatory bodies and national organizations have begun to require simulation of obstetrician-gynecologists, and the newer generation of physicians has experienced simulation throughout their training. Simulation is embedded in the medical culture and hopefully is making obstetrician-gynecologists better for it.
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Affiliation(s)
- Shena Dillon
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9032, USA.
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Does simulation improve clinical performance in management of postpartum hemorrhage? Am J Obstet Gynecol 2021; 225:435.e1-435.e8. [PMID: 34052191 DOI: 10.1016/j.ajog.2021.05.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although simulation is now widely used to improve teamwork and communication, data demonstrating improvement in clinical outcomes are limited. OBJECTIVE This study aimed to examine the clinical performance and outcomes associated with postpartum hemorrhage because of uterine atony following the implementation of a multidisciplinary simulation program. STUDY DESIGN This was a prospective observational study of response to postpartum hemorrhage because of uterine atony in an academic medical center before (epoch 1: July 2017-June 2018) and after (epoch 2: July 2019-June 2020) implementing a multidisciplinary simulation program. A total of 22 postpartum hemorrhage simulations were performed from July 2018 to June 2019 involving more than 300 nursing, obstetrical, and anesthesia providers. The simulation program focused on managing postpartum hemorrhage events and improving teamwork and communication of the multidisciplinary teams. To evaluate the clinical effectiveness of the simulation program, the primary outcome was response to postpartum hemorrhage defined as the time from the administration of uterotonic medications to transfusion of the first unit of blood in the first 12 hours following delivery, comparing epoch 2 to epoch 1 following the implementation of a simulation program. Statistical analysis included the use of the Pearson chi-square test, Wilcoxon rank-sum test, Hodges-Lehmann statistic for differences, and bootstrap methods with a P value of <.05 considered significant. RESULTS Between July 1, 2017, and June 30, 2018, there were 12,305 patients who delivered, of which 495 patients (4%) required transfusion. Between July 1, 2019, and June 30, 2020, there were 12,414 patients who delivered, of which 480 patients (4%) required transfusion. When isolating cases of postpartum hemorrhage because of uterine atony in both transfused groups, there were 157 women in the presimulation group (epoch 1) and 165 women in the postsimulation group (epoch 2), respectively. There was no difference in age, race, parity, or perinatal outcomes between the 2 epochs. Women in epoch 2 began receiving blood products significantly earlier in the first 12 hours following delivery compared with women in epoch 1 (51 [range, 28-125] minutes vs 102 [range, 32-320] minutes; P=.005). In addition, there was a significantly decreased variation in the time from the administration of uterotonic medications to transfusion of blood in epoch 2 (P=.035). Furthermore, women in epoch 2 had significantly lower estimated blood loss than women in epoch 1 (1250 [range, 1000-1750] mL vs 1500 [range, 1000-2000] mL; P=.032). CONCLUSION The implementation of a multidisciplinary simulation program at a large academic center focusing on the management of postpartum hemorrhage was associated with an improved clinical response. Specifically, there were significantly faster times from the administration of uterotonic medications to transfusion of blood, decreased variance in the time from the administration of uterotonic medications to transfusion of blood, and lower estimated blood loss following the implementation of a simulation program. Because delay in treatment is a major cause of preventable maternal death in obstetrical hemorrhage, the results in our study provided clinical evidence that a simulation program may improve patient outcomes in such emergencies.
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Renwick S, Hookes S, Draycott T, Dey M, Hodge F, Storey J, Winter C, Sengupta N, Benjamin F. PROMPT Wales project: national scaling of an evidence-based intervention to improve safety and training in maternity. BMJ Open Qual 2021; 10:e001280. [PMID: 34675036 PMCID: PMC8532559 DOI: 10.1136/bmjoq-2020-001280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 07/03/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In healthcare, there is increasing recognition of the importance of developing and testing strategies to scale effective interventions. The NHS long-term plan (2019) acknowledges that often a gold standard approach to a problem already exists somewhere within the NHS, however, it has not been replicated widely across the system. METHODS We describe the approach and process measures for national scaling of PROMPT (Practical Obstetric Multi-Professional Training) across 12 obstetric-led maternity units in Wales. PROMPT is an evidence-based training package for local maternity staff, previously associated with improvements in maternal and neonatal outcomes, reduction in litigation related to preventable harm and improved safety culture. PROMPT has previously been disseminated internationally using a train-the-trainer model. However, this has been associated with variations in uptake, fidelity and impact. In Wales, the project was supported by Welsh Government, and a structured scaling plan was developed, encompassing ongoing implementation support from a multi-professional team. RESULTS PROMPT was successfully implemented in all obstetric led units in Wales, with 326 local PROMPT facilitators trained, and 82.5%-100% of maternity staff attended a local PROMPT course in the first 15 months of the project (January 2019-March 2020). All training courses included evidence-based authentic elements, and 93% of courses in the first year (100/107) were supported by a national implementation team, providing coaching, implementation support and quality assurance. CONCLUSIONS Authentically scaling up complex interventions is a significant challenge. To replicate the improved outcomes demonstrated by PROMPT, intervention reach and fidelity must first be demonstrated.In this national scaling project, our scaling methodology led to the successful implementation of PROMPT across all health boards in Wales. Additionally, we demonstrated reduced variation in adoption, reach, timescale and intervention fidelity between maternity units with varying readiness for change, which had been difficult in two previous large-scale PROMPT implementation projects.
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Affiliation(s)
- Sophie Renwick
- Faculty of Medicine, University of Bristol, Bristol, UK
- PROMPT Maternity Foundation, Bristol, UK
| | - Sarah Hookes
- NHS Wales Shared Services Partnership Legal and Risk Services, Cardiff, UK
| | | | - Madhuchanda Dey
- Department of Obstetrics and Gynaecology, Singleton Hospital, Swansea, UK
| | - Frances Hodge
- Department of Obstetrics and Gynaecology, Singleton Hospital, Swansea, UK
| | | | | | - Niladri Sengupta
- Department of Obstetrics and Gynaecology, Betsi Cadwaladr University Health Board, Bodelwyddan, UK
| | - Fiona Benjamin
- Department of Obstetrics and Gynaecology, Princess of Wales Hospital, Bridgend, UK
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Karlgren K, Dahlström A, Birkestam A, Drevstam Norling A, Forss G, Andersson Franko M, Cooper S, Leijon T, Paulsson C. The TEAM instrument for measuring emergency team performance: validation of the Swedish version at two emergency departments. Scand J Trauma Resusc Emerg Med 2021; 29:139. [PMID: 34544459 PMCID: PMC8454124 DOI: 10.1186/s13049-021-00952-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/08/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The Team Emergency Assessment Measure (TEAM) questionnaire is designed for rating the non-technical performance of emergency medical teams during emergencies, e.g., resuscitation or trauma management. Originally developed in Australia it has today been translated and validated into eleven languages, but a Swedish version is lacking. The aim was therefore to cross-culturally translate and evaluate the reliability and validity of the TEAM questionnaire in a Swedish health care setting. METHODS The instrument was forward and backward translated and adapted into a Swedish context according to established guidelines for cross-cultural adaptation of survey-based measures. The translated version was tested through 78 pairwise assessments of 39 high-priority codes at the emergency departments of two major hospitals. The raters observed the teams at work in real time and filled in the questionnaires immediately afterwards independently of each other. Psychometric properties of the instrument were evaluated. RESULTS The original instrument was translated by pairs of translators independently of each other and reviewed by an expert committee of researchers, nurses and physicians from different specialties, a linguist and one of the original developers of the tool. A few adaptations were needed for the Swedish context. A principal component factor analysis confirmed a single 'teamwork' construct in line with the original instrument. The Swedish version showed excellent reliability with a Cronbach's alpha of 0.955 and a mean inter-item correlation of 0.691. The mean item-scale correlation of 0.82 indicated high internal consistency reliability. Inter-rater reliability was measured by intraclass correlation and was 0.74 for the global score indicating good reliability. Individual items ranged between 0.52 and 0.88. No floor effects but ceiling effects were noted. Finally, teams displaying clear closed-loop communication had higher TEAM scores than teams with less clear communication. CONCLUSIONS Real time observations of authentic, high priority cases at two emergency departments show that the Swedish version of the TEAM instrument has good psychometric properties for evaluating team performance. The TEAM instrument is thus a welcome tool for assessing non-technical skills of emergency medical teams.
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Affiliation(s)
- Klas Karlgren
- Department of Research, Education, Development and Innovation, Södersjukhuset, 118 83 Stockholm, Sweden
- MINT, Department Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, 5063 Bergen, Norway
| | - Anders Dahlström
- Department of Research, Education, Development and Innovation, Södersjukhuset, 118 83 Stockholm, Sweden
- Department of Neonatology, Sachs’ Children and Youth Hospital, Stockholm, Sweden
| | - Anderz Birkestam
- Department of Emergency, 118 83 Södersjukhuset, Stockholm, Sweden
| | | | - Gustav Forss
- Department of Emergency, 118 83 Södersjukhuset, Stockholm, Sweden
| | - Mikael Andersson Franko
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Södersjukhuset, 118 83 Stockholm, Sweden
| | - Simon Cooper
- Health Innovation and Transformation Centre (HITC), School of Health, Federation University Australia, Room 113, Building 1, Berwick Campus, Clyde Road, Berwick, VIC 3922 Australia
| | - Thomas Leijon
- Department of Emergency Medicine,
Capio S:t Göran’s Hospital
, 112 81 Stockholm, Sweden
| | - Charlotta Paulsson
- Department of Emergency Medicine,
Capio S:t Göran’s Hospital
, 112 81 Stockholm, Sweden
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Timothy CL, Brown AJ, Thomas EK. Implementation of a postarrest debriefing tool in a veterinary university hospital. J Vet Emerg Crit Care (San Antonio) 2021; 31:718-726. [PMID: 34432941 DOI: 10.1111/vec.13112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/04/2020] [Accepted: 04/25/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the use of a postarrest debriefing tool (DBT) within a university teaching hospital and to evaluate user perceptions of the tool. DESIGN Observational study over a 1-year period and associated hospital clinical personnel survey. SETTING University teaching hospital. INTERVENTIONS Qualitative data surrounding the use and utility of the DBT were analyzed, as well as survey results. MEASUREMENTS AND MAIN RESULTS Forty-four arrests occurred during the study period. Debriefing was performed after 26 of 44 (59%) cardiopulmonary resuscitation (CPR) events, of which 22 of 26 (85%) were recorded using the DBT and four without the DBT. Return of spontaneous circulation did not significantly affect the use of the DBT (p = 0.753). Most events in which debriefing was not performed occurred outside of business hours (13/18; 72%). The most frequent positive debriefing comments related to cooperation/coordination within the team (22/167; 13%). The most frequent negative debriefing comments concerned equipment issues (36/167; 22%). Of the action points generated, 57% (34/60) were directed at equipment use/availability. Teams reported that emergency drugs were appropriately administered in 21 of 22 (95%) cases. In contrast, closed loop communication was reportedly only used during 6 of 22 (27%) events. The hospital survey response rate was 56 of 338 (17%) clinical staff, of whom 37 of 56 (66%) agreed or strongly agreed that debriefing had improved team performance during CPR. Overall, 33 of 56 (60%) staff felt that the DBT had improved the debriefing process at the hospital. However, 3 of 56 (5%) staff members felt that they were unable to state their opinions in a blame-free environment during debriefing. CONCLUSIONS Implementation of a DBT enabled formal identification of strengths and training needs of resuscitation teams, and its implementation was viewed positively by the majority of hospital staff. However, further refinement of the tool and prospective studies evaluating its efficacy in improving outcome are warranted.
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Affiliation(s)
- Clare L Timothy
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | - Andrew J Brown
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | - Emily K Thomas
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
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Lavelle M, Reedy GB, Simpson T, Banerjee A, Anderson JE. Interprofessional teamwork for managing medical deterioration in pregnancy: what contributes to good clinical performance in simulated practice? BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:463-470. [PMID: 34603744 PMCID: PMC8445203 DOI: 10.1136/bmjstel-2020-000700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/14/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To identify the patterns of teamwork displayed by interprofessional teams during simulated management of medical deterioration in pregnancy and examine whether and how they are related to clinical performance in simulated practice. DESIGN Exploratory observational cohort study. SETTING Interprofessional clinical simulation training with scenarios involving the management of medical deterioration in pregnant women. PARTICIPANTS Seventeen simulated scenarios involving 62 qualified healthcare staff working within the National Health Service attending clinical simulation training (midwives (n=18), obstetricians (n=24) and medical physicians (n=20)). MAIN OUTCOME MEASURES Teamwork behaviours over time, obtained through detailed observational analysis of recorded scenarios, using the Temporal Observational Analysis of Teamwork (TOAsT) framework. Clinician rated measures of simulated clinical performance. RESULTS Scenarios with better simulated clinical performance were characterised by shared leadership between obstetricians and midwives at the start of the scenario, with obstetricians delegating less and midwives disseminating rationale, while both engaged in more information gathering behaviour. Towards the end of the scenario, better simulated clinical performance was associated with dissemination of rationale to the team. More delegation at the start of a scenario was associated with less spontaneous sharing of information and rationale later in the scenario. Teams that shared their thinking at the start of a scenario continued to do so over time. CONCLUSIONS Teamwork during the opening moments of a clinical situation is critical for simulated clinical performance in the interprofessional management of medical deterioration in pregnancy. Shared leadership and the early development of the shared mental model are associated with better outcomes.
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Affiliation(s)
- Mary Lavelle
- School of Health Sciences, City University of London, London, UK
| | - Gabriel B Reedy
- Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Thomas Simpson
- Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Lewisham and Greenwich NHS Trust, London, UK
| | - Anita Banerjee
- Women’s Services, Guys and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - Janet E Anderson
- School of Health Sciences, City University of London, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Dillon SJ, Kleinmann W, Seasely A, Ames R, Dyess-Nugent P, McIntire DD, Suen E, Nelson DB. How personality affects teamwork: a study in multidisciplinary obstetrical simulation. Am J Obstet Gynecol MFM 2020; 3:100303. [PMID: 33383231 DOI: 10.1016/j.ajogmf.2020.100303] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multidisciplinary simulation has been shown to improve teamwork in the obstetrical literature by providing a safe, but realistic, environment for participants to learn. However, the impact of team members' personality traits on how the team performs during an obstetrical emergency has not been studied in medicine. OBJECTIVE Our objective was to evaluate teamwork and communication of simulation participants in association with personality traits within a multidisciplinary obstetrical simulation program. STUDY DESIGN This was a prospective observational study of postpartum hemorrhage simulations involving participants from Obstetrics, Nursing, Midwifery, and Anesthesia. Before simulation, individual personality testing was performed on participants using the Big Five Inventory. Each team was scored using the Clinical Teamwork Scale after simulation. Communication and teamwork scores were evaluated for association, and personality traits were analyzed for association with teamwork and communication. For each personality trait, an interaction model was tested for 3 of the team scores: teamwork, communication, and situational awareness. Analysis of variance with 2 level interactions was used in this effort. RESULTS From July 2018 to June 2019, 22 obstetrical simulations were performed with a total of 270 staff. Overall, teamwork was significantly associated with communication for each team. When examining individual personality scores, neuroticism was negatively associated with teamwork when coupled with communication. That is, increased neuroticism was significantly associated with increased communication that was detrimental to the overall teamwork. Other personality traits were not significantly associated with teamwork and communication (P=.03). CONCLUSION In a multidisciplinary simulation, communication was positively associated with teamwork, and specific personality traits negatively affected team performance.
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Affiliation(s)
- Shena J Dillon
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Whitney Kleinmann
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Angela Seasely
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Rebecca Ames
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Phyllis Dyess-Nugent
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Donald D McIntire
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ellen Suen
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - David B Nelson
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
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Cheloufi M, Picard J, Hoffmann P, Bosson JL, Allenet B, Berveiller P, Albaladejo P. How to agree on what is fundamental to optimal teamwork performance in a situation of postpartum hemorrhage? A multidisciplinary Delphi French study to develop the Obstetric Team Performance Assessment Scale (OTPA Scale). Eur J Obstet Gynecol Reprod Biol 2020; 256:6-16. [PMID: 33161212 DOI: 10.1016/j.ejogrb.2020.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The objective of this study was to develop a new interdisciplinary teamwork scale, the Obstetric Team Performance Assessment (OTPA), for the management of the post-partum hemorrhage, through consensus agreement of obstetric caregivers. The goal is to provide a reliable tool for teaching and evaluating teams in high-fidelity simulation. METHODS This prospective study is based on an expert consensus, using a Delphi method. The authors developed the "OTPA» specifically related to the management of post-partum hemorrhage, using existing recommendations. For the Delphi survey, the scale was distributed to a selected group of experts. After each round of Delphi, authors quantitatively analyzed each element of the scale, based on the percentages of agreement received, and reviewed each comment. This blind examination then led to the modification of the scale. The rounds were continued until 80-100 % agreement with a median overall response score equal to or greater than 8 was obtained for at least 60 % of items. Repeated 3 times, the process led to consensus and to a final version of the OTPA scale. RESULTS From February to October 2018, 16 of the 33 invited experts participated in four Delphi cycles. Of the 37 items selected in the first round, only 19 (51.3 %) had an agreement of 80-100% with a median overall response score equal to or greater than 8 in the second round, and a third round was conducted. During this third round, 24 of the 37 items were validated (64.9 %) and 82 of the 88 sub-items obtained 80 %-100 % agreement (93.2 %). The fourth round consisted of proposing a weighting of the different items. CONCLUSION Using a structured Delphi method, we provided a new interdisciplinary teamwork scale (OTPA), for the management of the post-partum hemorrhage. Thus, this scale will be able to be used during high-fidelity scenarii to assess performances of various teams facing a scenari of PPH. Moreover, this scale, focusing some crucial aspects of interdisciplinary teamwork will be useful for teaching purpose.
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Affiliation(s)
- Meryam Cheloufi
- Department of Obstetrics and Gynecology, Armand Trousseau Children's Hospital, AP-HP, Paris, France.
| | - Julien Picard
- Department of Anesthesia and Critical Care, Simulation Center, Grenoble Alps University Hospital, Grenoble, France; TheMAS, TIMC, UMR-CNRS 5525, Clinical Investigation Center, Grenoble Alps University Hospital, Grenoble, France
| | - Pascale Hoffmann
- Department of Obstetrics and Gynecology, Armand Trousseau Children's Hospital, AP-HP, Paris, France
| | - Jean-Luc Bosson
- TheMAS, TIMC, UMR-CNRS 5525, Clinical Investigation Center, Grenoble Alps University Hospital, Grenoble, France
| | - Benoit Allenet
- TheMAS, TIMC, UMR-CNRS 5525, Clinical Investigation Center, Grenoble Alps University Hospital, Grenoble, France
| | - Paul Berveiller
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
| | - Pierre Albaladejo
- Department of Anesthesia and Critical Care, Simulation Center, Grenoble Alps University Hospital, Grenoble, France; TheMAS, TIMC, UMR-CNRS 5525, Clinical Investigation Center, Grenoble Alps University Hospital, Grenoble, France
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Cass GKS, Goyder K, Strachan B, Bahl R. Can we improve women's experience of operative vaginal birth? Eur J Obstet Gynecol Reprod Biol 2020; 252:424-430. [PMID: 32721840 DOI: 10.1016/j.ejogrb.2020.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/04/2020] [Accepted: 07/10/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE It is well understood that advanced skills are required for operative vaginal delivery to ensure a woman's birth experience is safe, positive and to prevent adverse long term harm. We sought to identify non-technical skills determined by women to enhance experience of operative vaginal delivery by qualitative analysis of interviews conducted during the postpartum period. DESIGN A qualitative study using semi structured interviews took place at a University teaching hospital. Sixteen women who had an operative delivery of a term baby underwent a semi structured interview at 6-8 weeks postnatal. The women were asked to reflect on good and bad experiences of their delivery and the interview was recorded verbatim. Thematic coding of data was carried out and then analysed. Women were given the option to review the transcript for respondent validation. The anonymised transcripts were independently coded by two researchers and then compared for consistency of interpretation. The themes that emerged following the final coding were used to identify a framework of behavioural and clinical skills. RESULTS We identified several non-technical skills that were important to women's' experience of operative delivery. Professional behaviour and relationships, decision making and communication, preconceptions and preparation for operative birth, teamwork, environment and consent were themes that emerged from women's experiences which can now provide clinicians with a comprehensive behavioural framework for operative vaginal delivery. CONCLUSION This illustration of detailed non-technical skills that has been validated by women could be used as part of clinical training and revalidation.
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Affiliation(s)
- Gemma K S Cass
- Department of Women's Health, St Michaels Hospital, Southwell Street, Bristol, BS2 8EG, United Kingdom.
| | - Karen Goyder
- Department of Women's Health, St Michaels Hospital, Southwell Street, Bristol, BS2 8EG, United Kingdom
| | - Bryony Strachan
- Department of Women's Health, St Michaels Hospital, Southwell Street, Bristol, BS2 8EG, United Kingdom
| | - Rachna Bahl
- Department of Women's Health, St Michaels Hospital, Southwell Street, Bristol, BS2 8EG, United Kingdom
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Cognitive aids with roles defined (CARD) for obstetrical crises: a multisite before-and-after cohort study. Can J Anaesth 2020; 67:970-980. [PMID: 32415478 DOI: 10.1007/s12630-020-01685-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Patient outcome during an obstetrical emergency depends on prompt coordination of an interprofessional team. The cognitive aids with roles defined (CARD) is a cognitive aid that addresses the issue of teamwork in crisis management. This study evaluated the clinical impact of implementing the CARD cognitive aid during emergency Cesarean deliveries. METHODS We conducted a prospective before-and-after cohort trial at the maternity units of two Canadian academic hospital campuses. Both sites received didactic online training regarding teamwork during crises, which involved training on using CARD for the "CARD" campus (intervention) and no mention of CARD at the "no CARD" campus (control). The primary outcome was the total time to delivery after the call for an emergency Cesarean delivery. Secondary outcomes included specific intervals of time within the time to delivery and clinical outcomes for both the babies and mothers. RESULTS We analyzed data from 267 eligible emergency Cesarean deliveries that occurred between January 11 2014 and December 31 2017. The use of CARD did not significantly change the median [interquartile range] time to delivery of the baby during an emergency Cesarean delivery from the pre-intervention to the post-intervention time period (17 [12-28] vs 15 [13-20], respectively; median difference, 2; 95% confidence interval, -1 to 5; P = 0.36). The clinical outcomes for the baby or the mother and other secondary outcomes also did not change. CONCLUSIONS The CARD cognitive aid did not significantly improve time-based or clinical maternal and neonatal outcomes of emergency Cesarean delivery at our academic maternity unit.
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Janssens S, Simon R, Barwick S, Beckmann M, Marshall S. Leadership sharing in maternity emergency teams: a retrospective cohort study in simulation. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 6:135-139. [PMID: 35518378 PMCID: PMC8936608 DOI: 10.1136/bmjstel-2018-000409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/10/2019] [Indexed: 11/03/2022]
Abstract
Background Shared leadership is associated with improved team performance in many domains, but little is understood about how leadership is shared spontaneously in maternity emergency teams, and if it is associated with improved team performance. Methods A video analysis study of multidisciplinary teams attending a maternity emergency management course was performed at a simulation centre colocated with a tertiary maternity hospital. Sixteen teams responding to a simulated postpartum haemorrhage were analysed between November 2016 and November 2017. Videos were transcribed, and utterances coded for leadership type using a coding system developed a priori. Distribution of leadership utterances between team members was calculated using the Gini coefficient. Teamwork was assessed using validated tools and clinical performance was assessed by time to perform a critical intervention and a checklist of required tasks. Results There was a significant sharing of leadership functions across the team despite the traditional recommendation for a singular leader, with the dominant leader only accounting for 58% of leadership utterances. There was no significant difference in Auckland Team Assessment Tool scores between high and low leadership sharing teams (5.02 vs 4.96, p=0.574). Time to critical intervention was shorter in low leadership sharing teams (193 s vs 312 s, p=0.018) but checklist completion did not differ significantly. Teams with better clinical performance had fewer leadership utterances beyond the dominant two leaders compared with poorer performing teams. Conclusions Leadership is spontaneously shared in maternity emergency teams despite the recommendation for singular leadership. Spontaneous leadership emerging from multiple team members does not appear to be associated with the improvements in team performance seen in other domains.
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Affiliation(s)
- Sarah Janssens
- Obstetrics and Gynaecology, Mater Mothers' Hospital, Brisbane, Queensland, Australia
- Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Robert Simon
- Center for Medical Simulation, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Michael Beckmann
- Obstetrics and Gynaecology, Mater Mothers' Hospital, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Stuart Marshall
- Monash University Central Clinical School, Melbourne, Victoria, Australia
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, Victoria, Australia
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Spranzi F, Norton C. From handover to takeover: should we consider a new conceptual model of communication? ACTA ACUST UNITED AC 2020. [DOI: 10.12968/bjom.2020.28.3.156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective This service evaluation aimed to collect data on clinical handover on labour ward and compare them with the local guideline. Design and methods This service evaluation was structured in four stages, each using a different design and research methods. Setting The study was undertaken between September 2013 and August 2014 in a maternity unit in a large NHS teaching hospital in London, UK. Findings and conclusion Communication breakdown is widely considered to be a significant factor contributing to poor patient outcomes, with handover being a major risk point. The discrepancy between the local guideline and current clinical practice reinforces the belief that urgent action is needed to improve clinical handover on labour ward. The results of this service evaluation suggest that a drastic overhaul of the communication model during handover should be considered, ie from handover to takeover, and that the mnemonic SBAR may not be fit-for-purpose in maternity care and should be replaced with a different format that reflects the chronological flow of clinical events.
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Affiliation(s)
- Francesca Spranzi
- Risk management support midwife, Imperial College Healthcare, NHS Trust
| | - Christine Norton
- Professor of clinical nursing research, Florence Nightingale faculty of nursing, midwifery and palliative care, King's College London
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Pomare C, Long JC, Churruca K, Ellis LA, Braithwaite J. Interprofessional collaboration in hospitals: a critical, broad-based review of the literature. J Interprof Care 2020; 34:509-519. [PMID: 31928245 DOI: 10.1080/13561820.2019.1702515] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Interprofessional collaboration (IPC) is a common term applied in the healthcare literature, with suggestions it contributes to improved quality and safety of patient care across the globe. Despite worldwide implementation of models of IPC, past systematic or meta-reviews on this topic have concluded that the evidence is mixed. However, these reviews are yet to adequately consider the qualitative and mixed-methods literature on this topic. In this critical review, we synthesize the outcomes and key findings of IPC in hospitals, taking a broader approach by including diverse study designs. A total of 4,776 abstracts were screened from three major databases (Medline, CINAHL, Embase). Thirty-four studies fulfilled inclusion criteria. Although outcomes and key findings (e.g., staff turnover, error rates) were mostly positive, there were inconsistencies in the results. The included studies reflected a variety of study designs and different methodological approaches. Overall, our review revealed moderate evidence that IPC can positively influence patient, staff and organizational factors in hospitals, and that inconsistent findings may be due to variation in context (e.g., the cohort of patients). Recommendations from the review are to incorporate qualitative- and mixed-methods approaches to studying IPC in healthcare and tailor evaluations of IPC outcomes specific to the context.
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Affiliation(s)
- Chiara Pomare
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
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Cooper N, O'Brien S, Siassakos D. Training health workers to prevent and manage post-partum haemorrhage (PPH). Best Pract Res Clin Obstet Gynaecol 2019; 61:121-129. [DOI: 10.1016/j.bpobgyn.2019.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/02/2019] [Indexed: 02/05/2023]
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Schmutz JB, Meier LL, Manser T. How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: a systematic review and meta-analysis. BMJ Open 2019; 9:e028280. [PMID: 31515415 PMCID: PMC6747874 DOI: 10.1136/bmjopen-2018-028280] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES To investigate the relationship between teamwork and clinical performance and potential moderating variables of this relationship. DESIGN Systematic review and meta-analysis. DATA SOURCE PubMed was searched in June 2018 without a limit on the date of publication. Additional literature was selected through a manual backward search of relevant reviews, manual backward and forward search of studies included in the meta-analysis and contacting of selected authors via email. ELIGIBILITY CRITERIA Studies were included if they reported a relationship between a teamwork process (eg, coordination, non-technical skills) and a performance measure (eg, checklist based expert rating, errors) in an acute care setting. DATA EXTRACTION AND SYNTHESIS Moderator variables (ie, professional composition, team familiarity, average team size, task type, patient realism and type of performance measure) were coded and random-effect models were estimated. Two investigators independently extracted information on study characteristics in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS The review identified 2002 articles of which 31 were included in the meta-analysis comprising 1390 teams. The sample-sized weighted mean correlation was r=0.28 (corresponding to an OR of 2.8), indicating that teamwork is positively related to performance. The test of moderators was not significant, suggesting that the examined factors did not influence the average effect of teamwork on performance. CONCLUSION Teamwork has a medium-sized effect on performance. The analysis of moderators illustrated that teamwork relates to performance regardless of characteristics of the team or task. Therefore, healthcare organisations should recognise the value of teamwork and emphasise approaches that maintain and improve teamwork for the benefit of their patients.
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Affiliation(s)
- Jan B Schmutz
- Department of Communication Studies, Northwestern University, Evanston, Illinois, USA
| | - Laurenz L Meier
- Department of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Tanja Manser
- FHNW School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
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Brogaard L, Kierkegaard O, Hvidman L, Jensen KR, Musaeus P, Uldbjerg N, Manser T. The importance of non-technical performance for teams managing postpartum haemorrhage: video review of 99 obstetric teams. BJOG 2019; 126:1015-1023. [PMID: 30771263 DOI: 10.1111/1471-0528.15655] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Little is known about how teams' non-technical performance influences clinical performance in obstetric emergencies such as postpartum haemorrhage. DESIGN Video review - observational study. SETTING A university hospital (5000 deliveries) and a regional hospital (2000 deliveries) in Denmark. POPULATION Obstetric teams managing real-life postpartum haemorrhage. METHODS We systematically assessed 99 video recordings of obstetric teams managing real-life major postpartum haemorrhage. Exposure was the non-technical score (AOTP); outcomes were the clinical performance score (TeamOBS) and the delayed transfer to the operating theatre (defined as blood loss >1500 ml in the delivery room). RESULTS Teams with an excellent non-technical score performed significantly better than teams with a poor non-technical score: 83.7 versus 0.3% chance of a high clinical performance score (P < 0.001), 0.2 versus 80% risk of a low clinical performance score (P < 0.001), and 3.5 versus 31.7% risk of delayed transfer to the operating theatre (P = 0.008). The results remained robust when adjusting for potential confounders such as bleeding velocity, aetiology, time of day, team size, and hospital. The specific non-technical skills associated with high clinical performance were vigilance, role assignment, problem-solving, management of disruptive behavior, and leadership. Communication with the patient and closing the loop were of minor importance. All performance assessments showed good reliability: the intraclass correlation was 0.97 (95% CI 0.96-0.98) for the non-technical score and 0.84 (95% CI 0.76-0.89) for the clinical performance score. CONCLUSION Video review offers a new method and new perspectives for research in obstetric teams to identify how teams become effective and safe; the skills identified in this study can be included in future obstetric training programmes. TWEETABLE ABSTRACT Non-technical performance is important for teams managing postpartum haemorrhage; video review of 99 obstetric teams.
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Affiliation(s)
- L Brogaard
- Department of Obstetrics and Gynaecology, Regional Hospital in Horsens, Horsens, Denmark
| | - O Kierkegaard
- Department of Obstetrics and Gynaecology, Regional Hospital in Horsens, Horsens, Denmark
| | - L Hvidman
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - K R Jensen
- Department of Obstetrics and Gynaecology, Regional Hospital in Horsens, Horsens, Denmark
| | - P Musaeus
- Centre for Health Sciences Education, INCUBA Science Park, Aarhus, Denmark
| | - N Uldbjerg
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - T Manser
- School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Altan, Switzerland
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Kirk L, Bahl R. Nontechnical skills and decision making in operative vaginal delivery. Best Pract Res Clin Obstet Gynaecol 2019; 56:23-34. [PMID: 30826158 DOI: 10.1016/j.bpobgyn.2019.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/01/2019] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
Abstract
Nontechnical skills are defined as social, cognitive and personal resource skills that are necessary to conduct any technical skill safely. Whilst the skills are categorised into three domains: social, cognitive and personal resources, these are dependent on each other and the development and effectiveness of one relies on the other two. Effective nontechnical skills are essential in the safe care of patients in any setting, and their importance can be clearly demonstrated in the safe development of skills in many areas of medicine and surgery. Increasingly the importance of these skills is being recognised in outcomes for patients and staff, and training courses and assessment tools are being developed and used in obstetrics. Understanding of the role of nontechnical skills in labour and especially in operative vaginal births should be embedded across the specialty. Further research is needed in validation of assessment tools for these skills when used in obstetrics.
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Affiliation(s)
- Lisa Kirk
- Department of Obstetrics & Gynaecology, St. Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8EG, UK
| | - Rachna Bahl
- Department of Obstetrics & Gynaecology, St. Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8EG, UK.
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Piloting a Multifaceted Interprofessional Education Program to Improve Physical Therapy and Nursing Students' Communication and Teamwork Skills. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2018. [DOI: 10.1097/jat.0000000000000077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Carroll K, Mesman J. Multiple Researcher Roles in Video-Reflexive Ethnography. QUALITATIVE HEALTH RESEARCH 2018; 28:1145-1156. [PMID: 29478407 DOI: 10.1177/1049732318759490] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Hospital-based video-reflexive ethnography (VRE) is a collaborative visual methodology used by researchers and/or health professionals to understand, interpret, and optimize health professionals' work practices and patients' experiences. For more than a decade, the VRE methodology has spread throughout (research) institutions and hospitals internationally, and VRE has evolved and broadened. Different ways of doing VRE have implications for the role of the researcher. A thorough examination of the consequences for the researcher's position is the central focus of this article. We outline three typical styles of researcher engagement with VRE: clinalyst, affect-as-method, and planned obsolescence. We argue that by examining these different styles of doing VRE research, academic researchers can then critically review and carefully choose which styles of VRE research best meet the needs of their research questions, their field relationships, their disciplinary background, and the expectations of their clinical research collaborators.
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Affiliation(s)
- Katherine Carroll
- 1 The Australian National University, Canberra, Australian Capital Territory, Australia
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El-Shafy IA, Delgado J, Akerman M, Bullaro F, Christopherson NAM, Prince JM. Closed-Loop Communication Improves Task Completion in Pediatric Trauma Resuscitation. JOURNAL OF SURGICAL EDUCATION 2018; 75:58-64. [PMID: 28780315 DOI: 10.1016/j.jsurg.2017.06.025] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 05/05/2017] [Accepted: 06/19/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Pediatric trauma care requires effective and clear communication in a time-sensitive manner amongst a variety of disciplines. Programs such as Crew Resource Management in aviation have been developed to systematically prevent errors. Similarly, teamSTEPPS has been promoted in healthcare with a strong focus on communication. We aim to evaluate the ability of closed-loop communication to improve time-to-task completion in pediatric trauma activations. METHODS All pediatric trauma activations from January to September, 2016 at an American College of Surgeons verified level I pediatric trauma center were video recorded and included in the study. Two independent reviewers identified and classified all verbal orders issued by the trauma team leader for order audibility, directed responsibility, check-back, and time-to-task-completion. The impact of pre-notification and level of activation on time-to-task-completion was also evaluated. All analyses were performed using SAS® version 9.4(SAS Institute Inc., Cary, NC). RESULTS In total, 89 trauma activation videos were reviewed, with 387 verbal orders identified. Of those, 126(32.6%) were directed, 372(96.1%) audible, and 101(26.1%) closed-loop. On average each order required 3.85 minutes to be completed. There was a significant reduction in time-to-task-completion when closed-loop communication was utilized (p < 0.0001). Orders with closed-loop communication were completed 3.6 times sooner as compared to orders with an open-loop [HR = 3.6 (95% CI: 2.5, 5.3)]. There was not a significant difference in time-to-task-completion with respect to pre-notification by emergency service providers (p < 0.6100). [HR = 1.1 (95% CI: 0.9, 1.3)]. There was also not a significant difference in time-to-task-completion with respect to level of trauma team activation (p < 0.2229). [HR = 1.3 (95% CI: 0.8, 2.1)]. CONCLUSION While closed-loop communication prevents medical errors, our study highlights the potential to increase the speed and efficiency with which tasks are completed in the setting of pediatric trauma resuscitation. Trauma drills and systems of communication that emphasize the use of closed-loop communication should be incorporated into the training of trauma team leaders. LEVEL OF EVIDENCE This is a prospective observational study with intervention level II evidence.
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Affiliation(s)
- Ibrahim Abd El-Shafy
- Department of Surgery, Hofstra Northwell School of Medicine, Cohen Children׳s Medical Center, New Hyde Park, New York; Feinstein Institute for Medical Research, Manhasset, New York; Department of Surgery, Maimonadies Medical Center, Brooklyn, New York
| | - Jennifer Delgado
- Department of Surgery, Hofstra Northwell School of Medicine, Cohen Children׳s Medical Center, New Hyde Park, New York
| | | | - Francesca Bullaro
- Department of Surgery, Hofstra Northwell School of Medicine, Cohen Children׳s Medical Center, New Hyde Park, New York
| | - Nathan A M Christopherson
- Department of Surgery, Hofstra Northwell School of Medicine, Cohen Children׳s Medical Center, New Hyde Park, New York; Department of Surgery, Maimonadies Medical Center, Brooklyn, New York
| | - Jose M Prince
- Department of Surgery, Hofstra Northwell School of Medicine, Cohen Children׳s Medical Center, New Hyde Park, New York; Feinstein Institute for Medical Research, Manhasset, New York; Trauma Institute, Northwell Health System, New York.
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Improving Nursing Communication Skills in an Intensive Care Unit Using Simulation and Nursing Crew Resource Management Strategies: An Implementation Project. J Nurs Care Qual 2017; 32:331-339. [PMID: 27875384 DOI: 10.1097/ncq.0000000000000241] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Effective interprofessional communication is critical to patient safety. This pre-/postimplementation project used a multifaceted educational strategy with high-fidelity simulation to introduce evidence-based communication tools, adapted from Nursing Crew Resource Management, to intensive care unit nurses. Results indicated that participants were satisfied with the education, and their perceptions of interprofessional communication and knowledge improved. Teams (n = 16) that used the communication tools during simulation were more likely to identify the problem, initiate key interventions, and have positive outcomes.
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Fransen AF, de Boer L, Kienhorst D, Truijens SE, van Runnard Heimel PJ, Oei SG. Assessing teamwork performance in obstetrics: A systematic search and review of validated tools. Eur J Obstet Gynecol Reprod Biol 2017; 216:184-191. [DOI: 10.1016/j.ejogrb.2017.06.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 06/15/2017] [Accepted: 06/23/2017] [Indexed: 02/08/2023]
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Bracco F, Masini M, De Tonetti G, Brogioni F, Amidani A, Monichino S, Maltoni A, Dato A, Grattarola C, Cordone M, Torre G, Launo C, Chiorri C, Celleno D. Adaptation of non-technical skills behavioural markers for delivery room simulation. BMC Pregnancy Childbirth 2017; 17:89. [PMID: 28302085 PMCID: PMC5356378 DOI: 10.1186/s12884-017-1274-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 03/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Simulation in healthcare has proved to be a useful method in improving skills and increasing the safety of clinical operations. The debriefing session, after the simulated scenario, is the core of the simulation, since it allows participants to integrate the experience with the theoretical frameworks and the procedural guidelines. There is consistent evidence for the relevance of non-technical skills (NTS) for the safe and efficient accomplishment of operations. However, the observation, assessment and feedback on these skills is particularly complex, because the process needs expert observers and the feedback is often provided in judgmental and ineffective ways. The aim of this study was therefore to develop and test a set of observation and rating forms for the NTS behavioural markers of multi-professional teams involved in delivery room emergency simulations (MINTS-DR, Multi-professional Inventory for Non-Technical Skills in the Delivery Room). METHODS The MINTS-DR was developed by adapting the existing tools and, when needed, by designing new tools according to the literature. We followed a bottom-up process accompanied by interviews and co-design between practitioners and psychology experts. The forms were specific for anaesthetists, gynaecologists, nurses/midwives, assistants, plus a global team assessment tool. We administered the tools in five editions of a simulation training course that involved 48 practitioners. Ratings on usability and usefulness were collected. RESULTS The mean ratings of the usability and usefulness of the tools were not statistically different to or higher than 4 on a 5-point rating scale. In either case no significant differences were found across professional categories. CONCLUSION The MINTS-DR is quick and easy to administer. It is judged to be a useful asset in maximising the learning experience that is provided by the simulation.
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Affiliation(s)
- Fabrizio Bracco
- Department of Educational Sciences, University of Genoa, Corso A. Podestà, 2, 16128, Genoa, Italy. .,V.I.E. srl, Spinoff of the University of Genoa, Genoa, Italy. .,Advanced Simulation Center, University of Genoa, Genoa, Italy. .,M.G. Vannini Hospital, Rome, Italy.
| | - Michele Masini
- V.I.E. srl, Spinoff of the University of Genoa, Genoa, Italy
| | | | | | - Arianna Amidani
- IRCCS Giannina Gaslini Children's Research Hospital, Genoa, Italy
| | - Sara Monichino
- IRCCS Giannina Gaslini Children's Research Hospital, Genoa, Italy
| | | | - Andrea Dato
- IRCCS Giannina Gaslini Children's Research Hospital, Genoa, Italy
| | | | - Massimo Cordone
- IRCCS Giannina Gaslini Children's Research Hospital, Genoa, Italy.,Advanced Simulation Center, University of Genoa, Genoa, Italy
| | - Giancarlo Torre
- Advanced Simulation Center, University of Genoa, Genoa, Italy
| | - Claudio Launo
- Advanced Simulation Center, University of Genoa, Genoa, Italy
| | - Carlo Chiorri
- Department of Educational Sciences, University of Genoa, Corso A. Podestà, 2, 16128, Genoa, Italy.,V.I.E. srl, Spinoff of the University of Genoa, Genoa, Italy
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Egenberg S, Øian P, Eggebø TM, Arsenovic MG, Bru LE. Changes in self-efficacy, collective efficacy and patient outcome following interprofessional simulation training on postpartum haemorrhage. J Clin Nurs 2017; 26:3174-3187. [DOI: 10.1111/jocn.13666] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2016] [Indexed: 01/27/2023]
Affiliation(s)
- Signe Egenberg
- Department of Obstetrics and Gynaecology; Stavanger University Hospital; Stavanger Norway
| | - Pål Øian
- Department of Obstetrics and Gynaecology; University Hospital of North Norway; Tromsø Norway
- Women's Health and Perinatology Research Group; Department of Clinical Medicine; University of Tromsø; Tromsø Norway
| | - Torbjørn Moe Eggebø
- Department of Obstetrics and Gynaecology; Stavanger University Hospital; Stavanger Norway
- National Center for Fetal Medicine; Trondheim University Hospital; Trondheim Norway
| | - Mirjana Grujic Arsenovic
- Division of Immunology and Transfusion Medicine; Department of Laboratory Medicine; University Hospital of North Norway; Tromsø Norway
| | - Lars Edvin Bru
- Department of Health Studies; University of Stavanger; Stavanger Norway
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Lumala A, Sekweyama P, Abaasa A, Lwanga H, Byaruhanga R. Assessment of quality of care among in-patients with postpartum haemorrhage and severe pre-eclampsia at st. Francis hospital nsambya: a criteria-based audit. BMC Pregnancy Childbirth 2017; 17:29. [PMID: 28086822 PMCID: PMC5237263 DOI: 10.1186/s12884-016-1219-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 12/31/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The maternal mortality ratio of Uganda is still high and the leading causes of maternal mortality are postpartum haemorrhage (PPH), severe pre-eclampsia and eclampsia. Criteria-based audit (CBA) is a way of improving quality of care that has not been commonly used in low income countries. This study aimed at finding out the quality of care provided to patients with these conditions and to find out if the implementation of recommendations from the audit cycle resulted in improvement in quality of care. METHODS This study was a CBA following a time series study design. It was done in St. Francis Hospital Nsambya and it involved assessment of adherence to standards of care for PPH, severe pre-eclampsia and eclampsia. An initial audit was done for 3 consecutive months, then findings were presented to health workers and recommendations made; we implemented the recommendations in a subsequent month and this comprised three interventions namely continuing medical education (CME), drills and displaying guidelines; a re-audit was done in the proceeding 3 consecutive months and analysis compared adherence rates of the initial audit with those of the re-audit. RESULTS Pearson Chi-Square test revealed that the adherence rates of 7 out of 10 standards of care for severe pre-eclampsia/eclampsia were statistically significantly higher in the re-audit than in the initial audit; also, the adherence rates of 3 out of 4 standards of care for PPH were statistically significantly higher in the re-audit than in the initial audit. CONCLUSION The giving of feedback on quality of care and the implementation of recommendations made during the CBA including CME, drills and displaying guidelines was associated with improvements in the quality of care for patients with PPH, severe pre-eclampsia and eclampsia.
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Affiliation(s)
| | - Peter Sekweyama
- Uganda Martyrs University Mother Kevin Postgraduate Medical School, Kampala, Uganda
| | | | | | - Romano Byaruhanga
- Uganda Martyrs University Mother Kevin Postgraduate Medical School, Kampala, Uganda
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Raynal P. [Simulation' benefits in obstetrical emergency: Which proof level?]. ACTA ACUST UNITED AC 2016; 44:584-590. [PMID: 27663913 DOI: 10.1016/j.gyobfe.2016.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022]
Abstract
Simulation in obstetrical emergency is in expansion. The important economic and human cost in simulation needs a real evaluation about enhancement in technical and non-technical skills, maternal and neonatal morbidity and mortality. We present a literature review of the results published on the subject in shoulder dystocia, post-partum haemorrhage, eclampsia and cord prolaps with a selection of publications with high evidence level or positive impact of training on obstetrical emergencies. There are few publications with a positive impact of training on obstetrical emergencies. Some publications from 10years by the same obstetrical team for training and shoulder dystocia reveal a 75% reduction in brachial plexus injury after 4years of training, and 100% reduction in permanent injury after a decade of training. Only one publication is in accordance with a reduction of severe post-partum haemorrhage with training. For all obstetrical emergencies, crew resource management (communication, self-confidence…) and team training are improved.
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Affiliation(s)
- P Raynal
- Service de gynécologie-obstétrique, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
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Johnson RH, Macpherson CF, Smith AW, Block RG, Keyton J. Facilitating Teamwork in Adolescent and Young Adult Oncology. J Oncol Pract 2016; 12:1067-1074. [PMID: 27624944 DOI: 10.1200/jop.2016.013870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A case of a young adult patient in the days immediately after a cancer diagnosis illustrates the critical importance of three interrelated core coordinating mechanisms-closed-loop communication, shared mental models, and mutual trust-of teamwork in an adolescent and young adult multidisciplinary oncology team. The case illustrates both the opportunities to increase team member coordination and the problems that can occur when coordination breaks down. A model for teamwork is presented, which highlights the relationships among these coordinating mechanisms and demonstrates how balance among them works to optimize team function and patient care. Implications for clinical practice and research suggested by the case are presented.
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Affiliation(s)
- Rebecca H Johnson
- Mary Bridge Hospital, MultiCare Health System, Tacoma, WA; Children's Hospital Los Angeles, Los Angeles, CA; National Cancer Institute, Bethesda, MD; Critical Mass: The Young Adult Cancer Alliance, Austin, TX; and North Carolina State University Raleigh, NC
| | - Catherine Fiona Macpherson
- Mary Bridge Hospital, MultiCare Health System, Tacoma, WA; Children's Hospital Los Angeles, Los Angeles, CA; National Cancer Institute, Bethesda, MD; Critical Mass: The Young Adult Cancer Alliance, Austin, TX; and North Carolina State University Raleigh, NC
| | - Ashley W Smith
- Mary Bridge Hospital, MultiCare Health System, Tacoma, WA; Children's Hospital Los Angeles, Los Angeles, CA; National Cancer Institute, Bethesda, MD; Critical Mass: The Young Adult Cancer Alliance, Austin, TX; and North Carolina State University Raleigh, NC
| | - Rebecca G Block
- Mary Bridge Hospital, MultiCare Health System, Tacoma, WA; Children's Hospital Los Angeles, Los Angeles, CA; National Cancer Institute, Bethesda, MD; Critical Mass: The Young Adult Cancer Alliance, Austin, TX; and North Carolina State University Raleigh, NC
| | - Joann Keyton
- Mary Bridge Hospital, MultiCare Health System, Tacoma, WA; Children's Hospital Los Angeles, Los Angeles, CA; National Cancer Institute, Bethesda, MD; Critical Mass: The Young Adult Cancer Alliance, Austin, TX; and North Carolina State University Raleigh, NC
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Welp A, Manser T. Integrating teamwork, clinician occupational well-being and patient safety - development of a conceptual framework based on a systematic review. BMC Health Serv Res 2016; 16:281. [PMID: 27430287 PMCID: PMC4950091 DOI: 10.1186/s12913-016-1535-y] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/01/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND There is growing evidence that teamwork in hospitals is related to both patient outcomes and clinician occupational well-being. Furthermore, clinician well-being is associated with patient safety. Despite considerable research activity, few studies include all three concepts, and their interrelations have not yet been investigated systematically. To advance our understanding of these potentially complex interrelations we propose an integrative framework taking into account current evidence and research gaps identified in a systematic review. METHODS We conducted a literature search in six major databases (Medline, PsycArticles, PsycInfo, Psyndex, ScienceDirect, and Web of Knowledge). Inclusion criteria were: peer reviewed papers published between January 2000 and June 2015 investigating a statistical relationship between at least two of the three concepts; teamwork, patient safety, and clinician occupational well-being in hospital settings, including practicing nurses and physicians. We assessed methodological quality using a standardized rating system and qualitatively appraised and extracted relevant data, such as instruments, analyses and outcomes. RESULTS The 98 studies included in this review were highly diverse regarding quality, methodology and outcomes. We found support for the existence of independent associations between teamwork, clinician occupational well-being and patient safety. However, we identified several conceptual and methodological limitations. The main barrier to advancing our understanding of the causal relationships between teamwork, clinician well-being and patient safety is the lack of an integrative, theory-based, and methodologically thorough approach investigating the three concepts simultaneously and longitudinally. Based on psychological theory and our findings, we developed an integrative framework that addresses these limitations and proposes mechanisms by which these concepts might be linked. CONCLUSION Knowledge about the mechanisms underlying the relationships between these concepts helps to identify avenues for future research, aimed at benefiting clinicians and patients by using the synergies between teamwork, clinician occupational well-being and patient safety.
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Affiliation(s)
- Annalena Welp
- Industrial Psychology and Human Factors, Department of Psychology, University of Fribourg, Rue Faucigny 2, 1700, Fribourg, Switzerland
| | - Tanja Manser
- Institute for Patient Safety, University Hospital Bonn, Stiftsplatz 12, 53111, Bonn, Germany. .,Department of Management, Technology & Economics, ETH Zurich, Weinbergstrasse 56/58, 8092, Zurich, Switzerland.
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Bansal A, Singh S, Rejai S, Rahman S, Park SA. Intraarticular Morphine Overdose: The Role of the Perioperative Physician. PAIN MEDICINE 2016; 17:2146-2148. [DOI: 10.1093/pm/pnw079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gough S, Yohannes AM, Murray J. Using video-reflexive ethnography and simulation-based education to explore patient management and error recognition by pre-registration physiotherapists. Adv Simul (Lond) 2016; 1:9. [PMID: 29449978 PMCID: PMC5806348 DOI: 10.1186/s41077-016-0010-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 02/17/2016] [Indexed: 11/10/2022] Open
Abstract
Background Upon graduation, physiotherapists are required to manage clinical caseloads involving deteriorating patients with complex conditions. In particular, emergency on-call physiotherapists are required to provide respiratory/cardio-respiratory/cardiothoracic physiotherapy, out of normal working hours, without senior physiotherapist support. To optimise patient safety, physiotherapists are required to function within complex clinical environments, drawing on their knowledge and skills (technical and non-technical), maintaining situational awareness and filtering unwanted stimuli from the environment. Prior to this study, the extent to which final-year physiotherapy students were able to manage an acutely deteriorating patient in a simulation context and recognise errors in their own practice was unknown. Methods A focused video-reflexive ethnography study was undertaken to explore behaviours, error recognition abilities and personal experiences of 21 final-year (pre-registration) physiotherapy students from one higher education institution. Social constructivism and complexity theoretical perspectives informed the methodological design of the study. Video and thematic analysis of 12 simulation scenarios and video-reflexive interviews were undertaken. Results Participants worked within the professional standards of physiotherapy practice expected of entry-level physiotherapists. Students reflected appropriate responses to their own and others' actions in the midst of uncertainty of the situation and physiological disturbances that unfolded during the scenario. However, they demonstrated a limited independent ability to recognise errors. Latent errors, active failures, error-producing factors and a series of effective defences to mitigate errors were identified through video analysis. Perceived influential factors affecting student performance within the scenario were attributed to aspects of academic and placement learning and the completion of a voluntary acute illness management course. The perceived value of the simulation scenario was enhanced by the opportunity to review their own simulation video with realism afforded by the scenario design. Conclusions This study presents a unique insight into the experiences, skills, attitudes, behaviours and error recognition abilities of pre-registration physiotherapy students managing an acutely deteriorating patient in a simulation context. Findings of this research provide valuable insights to inform future research regarding physiotherapy practice, integration of educational methods to augment patient safety awareness and participant-led innovations in safe healthcare practice.
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Affiliation(s)
- Suzanne Gough
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | | | - Janice Murray
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
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Härgestam M, Lindkvist M, Jacobsson M, Brulin C, Hultin M. Trauma teams and time to early management during in situ trauma team training. BMJ Open 2016; 6:e009911. [PMID: 26826152 PMCID: PMC4735161 DOI: 10.1136/bmjopen-2015-009911] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To investigate the association between the time taken to make a decision to go to surgery and gender, ethnicity, years in profession, experience of trauma team training, experience of structured trauma courses and trauma in the trauma team, as well as use of closed-loop communication and leadership styles during trauma team training. DESIGN In situ trauma team training. The patient simulator was preprogrammed to represent a severely injured patient (injury severity score: 25) suffering from hypovolemia due to external trauma. SETTING An emergency room in an urban Scandinavian level one trauma centre. PARTICIPANTS A total of 96 participants were divided into 16 trauma teams. Each team consisted of six team members: one surgeon/emergency physician (designated team leader), one anaesthesiologist, one registered nurse anaesthetist, one registered nurse from the emergency department, one enrolled nurse from the emergency department and one enrolled nurse from the operating theatre. PRIMARY OUTCOME HRs with CIs (95% CI) for the time taken to make a decision to go to surgery was computed from a Cox proportional hazards model. RESULTS Three variables remained significant in the final model. Closed-loop communication initiated by the team leader increased the chance of a decision to go to surgery (HR: 3.88; CI 1.02 to 14.69). Only 8 of the 16 teams made the decision to go to surgery within the timeframe of the trauma team training. Conversely, call-outs and closed-loop communication initiated by the team members significantly decreased the chance of a decision to go to surgery, (HR: 0.82; CI 0.71 to 0.96, and HR: 0.23; CI 0.08 to 0.71, respectively). CONCLUSIONS Closed-loop communication initiated by the leader appears to be beneficial for teamwork. In contrast, a high number of call-outs and closed-loop communication initiated by team members might lead to a communication overload.
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Affiliation(s)
- Maria Härgestam
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care, Umeå University, Umeå, Sweden
| | - Marie Lindkvist
- Department of Statistics, Umeå School of Business and Economics, Umeå International School of Public Health, Umeå University, Umeå, Sweden
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | | | - Magnus Hultin
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care, Umeå University, Umeå, Sweden
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Walton A, Kestler E, Dettinger JC, Zelek S, Holme F, Walker D. Impact of a low-technology simulation-based obstetric and newborn care training scheme on non-emergency delivery practices in Guatemala. Int J Gynaecol Obstet 2015; 132:359-64. [PMID: 26797198 PMCID: PMC4780429 DOI: 10.1016/j.ijgo.2015.08.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 07/24/2015] [Accepted: 11/23/2015] [Indexed: 11/30/2022]
Abstract
Objective To assess the effect of a low-technology simulation-based training scheme for obstetric and perinatal emergency management (PRONTO; Programa de Rescate Obstétrico y Neonatal: Tratamiento Óptimo y Oportuno) on non-emergency delivery practices at primary level clinics in Guatemala. Methods A paired cross-sectional birth observation study was conducted with a convenience sample of 18 clinics (nine pairs of intervention and control clinics) from June 28 to August 7, 2013. Outcomes included implementation of practices known to decrease maternal and/or neonatal mortality and improve patient care. Results Overall, 25 and 17 births occurred in intervention and control clinics, respectively. Active management of the third stage of labor was appropriately performed by 20 (83%) of 24 intervention teams versus 7 (50%) of 14 control teams (P = 0.015). Intervention teams implemented more practices to decrease neonatal mortality than did control teams (P < 0.001). Intervention teams ensured patient privacy in 23 (92%) of 25 births versus 11 (65%) of 17 births for control teams (P = 0.014). All 15 applicable intervention teams kept patients informed versus 6 (55%) of 11 control teams (P = 0.001). Differences were also noted in teamwork; in particular, skill-based tools were used more often at intervention sites than control sites (P = 0.012). Conclusion Use of PRONTO enhanced non-emergency delivery care by increasing evidence-based practice, patient-centered care, and teamwork.
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Affiliation(s)
- Anna Walton
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Edgar Kestler
- Epidemiological Research Center in Sexual and Reproductive Health, Guatemala City, Guatemala
| | - Julia C Dettinger
- Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Sarah Zelek
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Francesca Holme
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Dilys Walker
- Department of Obstetrics and Gynecology and Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
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Till H, Ker J, Myford C, Stirling K, Mires G. Constructing and evaluating a validity argument for the final-year ward simulation exercise. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2015; 20:1263-1289. [PMID: 25808311 DOI: 10.1007/s10459-015-9601-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 03/13/2015] [Indexed: 06/04/2023]
Abstract
The authors report final-year ward simulation data from the University of Dundee Medical School. Faculty who designed this assessment intend for the final score to represent an individual senior medical student's level of clinical performance. The results are included in each student's portfolio as one source of evidence of the student's capability as a practitioner, professional, and scholar. Our purpose in conducting this study was to illustrate how assessment designers who are creating assessments to evaluate clinical performance might develop propositions and then collect and examine various sources of evidence to construct and evaluate a validity argument. The data were from all 154 medical students who were in their final year of study at the University of Dundee Medical School in the 2010-2011 academic year. To the best of our knowledge, this is the first report on an analysis of senior medical students' clinical performance while they were taking responsibility for the management of a simulated ward. Using multi-facet Rasch measurement and a generalizability theory approach, we examined various sources of validity evidence that the medical school faculty have gathered for a set of six propositions needed to support their use of scores as measures of students' clinical ability. Based on our analysis of the evidence, we would conclude that, by and large, the propositions appear to be sound, and the evidence seems to support their proposed score interpretation. Given the body of evidence collected thus far, their intended interpretation seems defensible.
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Affiliation(s)
- Hettie Till
- Centre for Medical Education, School of Medicine, University of Dundee, Dundee, UK.
- , 11 Van Riebeeck Street, Franschhoek, 7690, South Africa.
| | - Jean Ker
- School of Medicine, University of Dundee, Dundee, UK
| | - Carol Myford
- Department of Educational Psychology, College of Education, University of Illinois at Chicago, Chicago, IL, USA
| | - Kevin Stirling
- Clinical Skills Centre, School of Medicine, University of Dundee, Dundee, UK
| | - Gary Mires
- School of Medicine, University of Dundee, Dundee, UK
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Higgins M, Kfouri J, Biringer A, Seaward G, Windrim R. Teaching an Experienced Multidisciplinary Team About Postpartum Hemorrhage: Comparison of Two Different Methods. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:824-828. [PMID: 26605454 DOI: 10.1016/s1701-2163(15)30155-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Morbidity from postpartum hemorrhage (PPH) affects 20% of pregnancies worldwide and remains a significant cause of maternal mortality. This study compared the impressions of experienced clinicians on the effect of two methods of educational interventions in a MoreOB training program designed to improve recognition and management of PPH. METHODS Participants were exposed to a traditional didactic lecture and an interactive clinical intervention exercise incorporating video simulation of a PPH event with opportunities for feedback and discussion of how to proceed. They were then invited to respond to a questionnaire regarding their impressions of both methods. RESULTS Of 150 participants, 110 completed the questionnaire. Respondents considered the interactive format to be more effective (55%) and enjoyable (72%) than the traditional didactic format. The majority (81%), however, still recommended a mixture of both interactive and didactic formats in future events, supported by a multidisciplinary drill. CONCLUSION Clinical learners value interactivity and mutual reinforcement among varied learning exercises in their educational experiences. Future educational programs may consider incorporating similar methods in order to maximize participants' receptiveness.
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Affiliation(s)
- Mary Higgins
- Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto ON; Department of Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Julia Kfouri
- Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto ON; Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON
| | - Anne Biringer
- Department of Family and Community Medicine, University of Toronto, Mount Sinai Hospital, Toronto ON
| | - Gareth Seaward
- Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto ON; Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON
| | - Rory Windrim
- Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto ON; Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON
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