1
|
Kohler P, Larsen A, Abuna F, Owiti G, Sila J, Owens T, Kemunto V, Lagat H, Vera M, Richardson BA, Wilson K, Pintye J, John-Stewart G, Kinuthia J. Patient actor training improves preexposure prophylaxis delivery for adolescent girls and young women in Kenya: a cluster randomized trial. AIDS 2024; 38:1505-1512. [PMID: 38857513 PMCID: PMC11288181 DOI: 10.1097/qad.0000000000003943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
OBJECTIVE To evaluate effectiveness of a standardized patient actor (SP) training intervention to improve quality of preexposure prophylaxis (PrEP) services for adolescent girls and young women (AGYW) in Kenya. DESIGN Cluster randomized trial and mystery shopper evaluation. METHODS Twelve of 24 maternal child health and family planning facilities were randomized to SP training. Providers at intervention facilities participated in 2-day training in adolescent health, PrEP guidelines, values clarification, and communication skills, followed by role-playing and de-briefing with trained actors. Control facilities received standard national training. The primary outcome was quality of care, assessed by unannounced SPs (USPs) or "mystery shoppers" blinded to intervention arm. Quality was measured in two domains: guideline adherence and communication skills. Intent to treat analysis compared postintervention quality scores by randomization arm, clustering on facility, and adjusting for baseline scores and USP. RESULTS Overall, 232 providers consented to USP visits, and 94 providers completed the training. Following training, USPs posed as AGYW seeking PrEP in 142 encounters (5-6 encounters per site). The mean quality score was 73.6% at intervention sites and 58.4% at control sites [adjusted mean difference = 15.3, 95% confidence interval (CI): 9.4-21.1, P < 0.001]. Mean guideline adherence scores were 57.2% at intervention sites and 36.2% at control sites (adjusted mean difference = 21.0, 95% CI: 12.5-29.4, P < 0.001). Mean communication scores were 90.0% at intervention sites and 80.5% at control sites (adjusted mean difference = 9.5, 95% CI: 5.5-13.6, P < 0.001). CONCLUSIONS SP training significantly improved quality of PrEP care for AGYW in Kenya. Incorporating SP training and unannounced SP evaluation could improve PrEP uptake among AGYW.
Collapse
Affiliation(s)
- Pamela Kohler
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle USA
- Department of Global Health, University of Washington, Seattle USA
| | - Anna Larsen
- Department of Global Health, University of Washington, Seattle USA
- Department of Epidemiology, University of Washington, Seattle USA
| | - Felix Abuna
- Department of Research and Programs, Kenyatta National Hospital, Nairobi KENYA
| | - George Owiti
- Department of Research and Programs, Kenyatta National Hospital, Nairobi KENYA
| | - Joseph Sila
- Department of Research and Programs, Kenyatta National Hospital, Nairobi KENYA
| | - Tamara Owens
- Clinical Skills and Simulation Center, Howard University, Washington DC USA
| | - Valerie Kemunto
- Department of Research and Programs, Kenyatta National Hospital, Nairobi KENYA
| | - Harrison Lagat
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle USA
- Department of Research and Programs, Kenyatta National Hospital, Nairobi KENYA
| | - Melissa Vera
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle USA
| | - Barbra A Richardson
- Department of Global Health, University of Washington, Seattle USA
- Department of Biostatistics University of Washington, Seattle USA
| | - Kate Wilson
- Department of Global Health, University of Washington, Seattle USA
| | - Jillian Pintye
- Department of Biobehavioral Nursing and Health Informatics, Seattle USA
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle USA
- Department of Pediatrics, University of Washington, Seattle USA
- Department of Allergy and Infectious Diseases, University of Washington, Seattle USA
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi KENYA
| |
Collapse
|
2
|
Fatherree DL, Palokas M. Postpartum hemorrhage prevention and management in women in an inpatient postpartum unit: a best practice implementation project. JBI Evid Implement 2024; 22:140-148. [PMID: 37965726 DOI: 10.1097/xeb.0000000000000395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
INTRODUCTION AND OBJECTIVES Ninety percent of maternal deaths are attributed to postpartum hemorrhage, with 50% being preventable. Annually, University of Mississippi Medical Center staff have more than 20,000 obstetrical encounters and deliver thousands of infants, with ∼75% being high-risk. The mother/baby unit, 3 Wiser, experienced two postpartum hemorrhages in August 2022. Post-event debriefings revealed opportunities for improvement. This project aimed to promote evidence-based practices regarding the prevention and management of postpartum hemorrhage in 3 Wiser. METHODS The project was guided by the JBI Model of Evidence-Based Healthcare and used the JBI Practical Application of Clinical Evidence System together with the Getting Research into Practice audit and feedback strategy. Four evidence-based practices were selected as audit criteria. After baseline audits were conducted, strategies to improve compliance with evidence-based practices were implemented. Finally, a follow-up audit was conducted, and the results of both audits were compared. RESULTS The baseline audits revealed 84% average compliance with the four evidence-based practices. Strategies to improve compliance included a simulation for nursing staff with a review of postpartum hemorrhage policies and skills. The post-implementation audit revealed 98% average compliance with the four evidence-based practices, a 14% increase from the baseline audit. CONCLUSIONS This evidence implementation project utilized a clinical audit process, which led to improvements in practice related to the prevention and management of postpartum hemorrhage in the inpatient postpartum unit.
Collapse
Affiliation(s)
- Debi Lane Fatherree
- School of Nursing, University of Mississippi Medical Center, Jackson, MI, USA
- Mississippi Centre for Evidence-Based Practice: A JBI Centre of Excellence, Jackson, MI, USA
| | - Michelle Palokas
- School of Nursing, University of Mississippi Medical Center, Jackson, MI, USA
- Mississippi Centre for Evidence-Based Practice: A JBI Centre of Excellence, Jackson, MI, USA
| |
Collapse
|
3
|
Araújo NM, da Costa Silveira de Camargo J, Ochiai AM, Ferreira FM, Riesco MLG. Instructional and didactic support tool for teaching-learning Post-Partum Haemorrhage care in simulated settings: Creation and validation. Nurse Educ Pract 2024; 74:103867. [PMID: 38101091 DOI: 10.1016/j.nepr.2023.103867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/16/2023] [Accepted: 11/26/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE To describe the creation and validation process of an instructional, didactic and self-applied support tool for teaching-learning Post-Partum Haemorrhage care in simulated settings. BACKGROUND Students frequently face difficulties performing the actions in the proper sequence in Post-Partum Haemorrhage simulated cases. Even in a controlled environment, anxiety, nervousness and fear of making mistakes are evident, which render the simulated experience highly stressful. Having a tool with a guideline can help students perform these actions more assertively. DESIGN A methodological study to develop a didactic tool. METHODS The creation process of the didactic tool, called Instructional Disk for the Management of Post-Partum Haemorrhage, was divided into five phases: Analysis, Design, Development, Implementation and Evaluation. Nine experts specialised in Obstetrics and Midwifery validated the tool by answering a questionnaire with nine items; in turn, 32 undergraduate Midwifery program students carried out the evaluation using a questionnaire on applicability, functionality, clarity, coherence and usability of the tool in Post-Partum Haemorrhage simulated stations. The data were analysed descriptively, considering absolute agreement when the answers to all questions in the five-point Likert scale corresponded to 5 (I totally agree). The Content Validity Index was calculated for the experts' questionnaires. RESULTS In the validation stage, the experts agreed or totally agreed with all nine items, reaching a Content Validity Index = 1. In the total scores assigned by the experts, there was a variation between 80.0% and 100% absolute agreement, with a mean of 95.6%. In the students' assessment, the variation was between 87.5% and 100% absolute agreement, with a mean of 97.7%, in the eight items evaluated. The agreement level above 90% among experts and students was considered high. CONCLUSIONS The Instructional Disk for the Management of Post-Partum Haemorrhage was validated by experts with extensive experience in Obstetrics and Midwifery care and teaching, ensuring that the content included in the guidelines for the management of Post-Partum Haemorrhage adopted in Brazil is covered. The students positively evaluated this support tool for learning the care to be provided in Post-Partum Haemorrhage cases in the simulated stations.
Collapse
Affiliation(s)
- Natalucia Matos Araújo
- Faculty of Midwifery Course School of Arts, Sciences and Humanities, Street Arlindo Bettio, 1000, ZIP 03828-000, Sao Paulo, SP, Brazil.
| | | | - Angela Megumi Ochiai
- Faculty of Midwifery Course School of Arts, Sciences and Humanities, Street Arlindo Bettio, 1000, ZIP 03828-000, Sao Paulo, SP, Brazil
| | - Fernanda Marçal Ferreira
- Faculty University of Sao Paulo School of Nurse, Avenue Dr. Enéas Carvalho de Aguiar, 419 - Cerqueira César, ZIP 05403-000, Sao Paulo, SP, Brazil
| | - Maria Luiza Gonzalez Riesco
- University of Sao Paulo School of Nurse, Avenue Dr. Enéas Carvalho de Aguiar, 419 - Cerqueira César, ZIP 05403-000, Sao Paulo, SP, Brazil
| |
Collapse
|
4
|
Lee JS, Day G, Valentino D, Hedges C, Decker C, Booth J, Lockey R, Schroeppel TJ. Help a mother out: The impact of acute care surgeon response in postpartum hemorrhage. Am J Surg 2023; 226:882-885. [PMID: 37532591 DOI: 10.1016/j.amjsurg.2023.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/03/2023] [Accepted: 07/22/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION A Code White (CW) activation is a hospital-wide alert for postpartum hemorrhage (PPH) and acute care surgeons (ACS) were added to the response team to assist in resuscitation. A multidisciplinary training program was also implemented. This study aimed to evaluate the impact of ACS involvement and training on maternal outcomes. METHODS A retrospective review was performed on all CW activations from 1/1/2015-8/31/2022. Three groups-pre-ACS response, ACS response, and ACS response + training (R&T)-were compared. RESULTS 218 patients had CW activations. ACS response increased MTP activations (50.0%vs76.5%vs76.2%, p = 0.014) and TXA administration (50.0%vs96.5%vs93.3%, p < 0.0001). The ACS R&T had the highest ACS presence (53.6%vs72.9%vs96.2%, p < 0.0001), shortest operation (99 vs 67 vs 53min, p = 0.002), lowest crystalloid use (2000 vs 1110 vs 800 ml, p = 0.003), and lowest transfusion requirements. Mortality decreased from 17.9% in pre-ACS to 2.4% in ACS response and 0% in ACS R&T (p < 0.0001). CONCLUSION ACS assistance in CW activations and multidisciplinary PPH education led to the prevention of maternal mortality. ACS are a valuable resource in this unique population.
Collapse
Affiliation(s)
- Janet S Lee
- Department of Trauma and Acute Care Surgery, University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA; Department of Surgery, University of Colorado, Aurora, CO, USA.
| | - Gregory Day
- Department of Trauma and Acute Care Surgery, University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA.
| | - Daniel Valentino
- Department of Trauma and Acute Care Surgery, University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA.
| | - Caroline Hedges
- Department of Obstetrics and Gynecology, University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA.
| | - Cassie Decker
- Department of Trauma Research, University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA.
| | - Jessica Booth
- Department of Anesthesiology, University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA.
| | - Renee Lockey
- Department of Obstetrics and Gynecology, University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA.
| | - Thomas J Schroeppel
- Department of Trauma and Acute Care Surgery, University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA.
| |
Collapse
|
5
|
Vamos CA, Foti TR, Reyes Martinez E, Pointer Z, Detman LA, Sappenfield WM. Identification of Clinician Training Techniques as an Implementation Strategy to Improve Maternal Health: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6003. [PMID: 37297607 PMCID: PMC10252379 DOI: 10.3390/ijerph20116003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
Training is a key implementation strategy used in healthcare settings. This study aimed to identify a range of clinician training techniques that facilitate guideline implementation, promote clinician behavior change, optimize clinical outcomes, and address implicit biases to promote high-quality maternal and child health (MCH) care. A scoping review was conducted within PubMed, CINAHL, PsycInfo, and Cochrane databases using iterative searches related to (provider OR clinician) AND (education OR training). A total of 152 articles met the inclusion/exclusion criteria. The training involved multiple clinician types (e.g., physicians, nurses) and was predominantly implemented in hospitals (63%). Topics focused on maternal/fetal morbidity/mortality (26%), teamwork and communication (14%), and screening, assessment, and testing (12%). Common techniques included didactic (65%), simulation (39%), hands-on (e.g., scenario, role play) (28%), and discussion (27%). Under half (42%) of the reported training was based on guidelines or evidence-based practices. A minority of articles reported evaluating change in clinician knowledge (39%), confidence (37%), or clinical outcomes (31%). A secondary review identified 22 articles related to implicit bias training, which used other reflective approaches (e.g., implicit bias tests, role play, and patient observations). Although many training techniques were identified, future research is needed to ascertain the most effective training techniques, ultimately improving patient-centered care and outcomes.
Collapse
Affiliation(s)
- Cheryl A. Vamos
- USF’s Center of Excellence in Maternal and Child Health Education, Science & Practice, The Chiles Center, College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Tara R. Foti
- College of Public Health, University of South Florida, Tampa, FL 33612, USA; (T.R.F.); (Z.P.)
| | - Estefanny Reyes Martinez
- College of Public Health, Florida Perinatal Quality Collaborative, University of South Florida, Tampa, FL 33612, USA;
| | - Zoe Pointer
- College of Public Health, University of South Florida, Tampa, FL 33612, USA; (T.R.F.); (Z.P.)
| | - Linda A. Detman
- The Chiles Center, College of Public Health, Florida Perinatal Quality Collaborative, University of South Florida, Tampa, FL 33612, USA; (L.A.D.); (W.M.S.)
| | - William M. Sappenfield
- The Chiles Center, College of Public Health, Florida Perinatal Quality Collaborative, University of South Florida, Tampa, FL 33612, USA; (L.A.D.); (W.M.S.)
| |
Collapse
|
6
|
Obstetric Simulation Training and Teamwork: Immediate Impact on Knowledge, Teamwork, and Adherence to Hemorrhage Protocols. Simul Healthc 2023; 18:32-41. [PMID: 35136007 DOI: 10.1097/sih.0000000000000641] [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
INTRODUCTION The Obstetric Simulation Training and Teamwork (OB-STaT) curriculum was an in situ interprofessional program to provide standardized postpartum hemorrhage (PPH) simulation training throughout a health system to decrease PPH morbidity. In this study portion, investigators hypothesized that OB-STaT would increase: (a) team member knowledge in diagnosis and management of PPH, (b) teamwork, (c) adherence to established PPH protocols, and (d) patient satisfaction. METHODS The OB-STaT was implemented at 8 US Navy hospitals between February 2018 and November 2019. Participant PPH treatment and maternal/neonatal resuscitation pretraining/posttraining knowledge was assessed via an 11-item test, whereas teamwork and standardized patient assessment were rated using validated Likert-type scales: the 15-item Clinical Teamwork Scale and 3-item Patient Perception Score, with item ranges of 0 to 10 and 0 to 5, respectively. Local PPH protocol adherence was assessed using role-specific checklists, with a potential maximum of 14 points (anesthesia/nursing) or 22 points (obstetrics). RESULTS Fifty-four interprofessional teams participated. Obstetricians (trainees and attendings) demonstrated significantly improved knowledge test scores (8.33 ± 1.6 vs. 8.66 ± 1.5, P < 0.01). Between the 2 scenarios, overall mean Clinical Teamwork Scale scores improved significantly for all interprofessional teams (5.82 ± 2.0 vs. 7.25 ± 1.9, P < 0.01). Anesthesia, nursing, and obstetric subteams demonstrated significant increases in protocol adherence as measured by critical action scores (12.28 ± 1.7 vs. 13.56 ± 1.0, 12.43 ± 1.6 vs. 13.14 ± 1.3, and 18.14 ± 2.7 vs. 19.56 ± 2.1 respectively, all P < 0.02). Although overall standardized patient satisfaction did not significantly improve, scores for feeling well informed did (3.36 ± 1.0 vs. 3.76 ± 0.8, P < 0.01). CONCLUSIONS The OB-STaT curriculum modestly improved participants' teamwork, communication, and protocol adherence during simulated PPH scenarios; OB-STaT may decrease PPH morbidity.
Collapse
|
7
|
Postpartum hemorrhage: The role of simulation. Best Pract Res Clin Anaesthesiol 2022; 36:433-439. [PMID: 36513437 DOI: 10.1016/j.bpa.2022.11.002] [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: 10/17/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
Postpartum hemorrhage (PPH) persists as a leading cause of maternal death worldwide, and in the United States, most maternal deaths due to hemorrhage are deemed preventable. While essential preparations for hemorrhage include protocols and checklists, implementation science has revealed that it is not enough to merely introduce these tools into units. Simulation affords safe opportunities for practice and produces reliable behavior change, and it does not always need to be highly expensive and resource consuming. We review how simulation can be applied to address a unit's vulnerabilities in identifying, managing, and resolving PPH, as well as considerations for crafting a comprehensive simulation program for your unit.
Collapse
|
8
|
Evans K, Woodruff J, Cowley A, Bramley L, Miles G, Ross A, Cooper J, Baxendale B. GENESISS 2-Generating Standards for In-Situ Simulation project: a systematic mapping review. BMC MEDICAL EDUCATION 2022; 22:537. [PMID: 35818052 PMCID: PMC9272657 DOI: 10.1186/s12909-022-03401-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In-situ simulation is increasingly employed in healthcare settings to support learning and improve patient, staff and organisational outcomes. It can help participants to problem solve within real, dynamic and familiar clinical settings, develop effective multidisciplinary team working and facilitates learning into practice. There is nevertheless a reported lack of a standardised and cohesive approach across healthcare organisations. The aim of this systematic mapping review was to explore and map the current evidence base for in-situ interventions, identify gaps in the literature and inform future research and evaluation questions. METHODS A systematic mapping review of published in-situ simulation literature was conducted. Searches were conducted on MEDLINE, EMBASE, AMED, PsycINFO, CINAHL, MIDIRS and ProQuest databases to identify all relevant literature from inception to October 2020. Relevant papers were retrieved, reviewed and extracted data were organised into broad themes. RESULTS Sixty-nine papers were included in the mapping review. In-situ simulation is used 1) as an assessment tool; 2) to assess and promote system readiness and safety cultures; 3) to improve clinical skills and patient outcomes; 4) to improve non-technical skills (NTS), knowledge and confidence. Most studies included were observational and assessed individual, team or departmental performance against clinical standards. There was considerable variation in assessment methods, length of study and the frequency of interventions. CONCLUSIONS This mapping highlights various in-situ simulation approaches designed to address a range of objectives in healthcare settings; most studies report in-situ simulation to be feasible and beneficial in addressing various learning and improvement objectives. There is a lack of consensus for implementing and evaluating in-situ simulation and further studies are required to identify potential benefits and impacts on patient outcomes. In-situ simulation studies need to include detailed demographic and contextual data to consider transferability across care settings and teams and to assess possible confounding factors. Valid and reliable data collection tools should be developed to capture the complexity of team and individual performance in real settings. Research should focus on identifying the optimal frequency and length of in-situ simulations to improve outcomes and maximize participant experience.
Collapse
Affiliation(s)
- Kerry Evans
- Nottingham University Hospitals Trust, Institute of Care Excellence, Nottingham, UK
| | | | - Alison Cowley
- Nottingham University Hospitals Trust, Research & Innovation, Nottingham, UK
| | - Louise Bramley
- Nottingham University Hospitals Trust, Institute of Care Excellence, Nottingham, UK
| | - Giulia Miles
- Trent Simulation & Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, Notts UK
| | - Alastair Ross
- Glasgow Dental School, University of Glasgow, Glasgow, UK
| | - Joanne Cooper
- Nottingham University Hospitals Trust, Institute of Care Excellence, Nottingham, UK
| | - Bryn Baxendale
- Trent Simulation & Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, Notts UK
| |
Collapse
|
9
|
Baxendale B, Evans K, Cowley A, Bramley L, Miles G, Ross A, Dring E, Cooper J. GENESISS 1-Generating Standards for In-Situ Simulation project: a scoping review and conceptual model. BMC MEDICAL EDUCATION 2022; 22:479. [PMID: 35725432 PMCID: PMC9208746 DOI: 10.1186/s12909-022-03490-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/23/2022] [Indexed: 05/04/2023]
Abstract
BACKGROUND In-Situ Simulation (ISS) enables teams to rehearse and review practice in the clinical environment to facilitate knowledge transition, reflection and safe learning. There is increasing use of ISS in healthcare organisations for which patient safety and quality improvement are key drivers. However, the effectiveness of ISS interventions has not yet been fully demonstrated and requires further study to maximise impact. Cohesive programmatic implementation is lacking and efforts to standardise ISS terms and concepts, strengthen the evidence base and develop an integrated model of learning is required. The aim of this study was to explore the current evidence, theories and concepts associated with ISS across all areas of healthcare and develop a conceptual model to inform future ISS research and best practice guidance. METHODS A scoping review was undertaken with stakeholder feedback to develop a conceptual model for ISS. Medline, OpenGrey and Web of Science were searched in September 2018 and updated in December 2020. Data from the included scoping review studies were analysed descriptively and organised into categories based on the different motivations, concepts and theoretical approaches for ISS. Categories and concepts were further refined through accessing stakeholder feedback. RESULTS Thirty-eight papers were included in the scoping review. Papers reported the development and evaluation of ISS interventions. Stakeholder groups highlighted situations where ISS could be suitable to improve care and outcomes and identified contextual and practical factors for implementation. A conceptual model of ISS was developed which was organised into four themes: 1. To understand and explore why systematic events occur in complex settings; 2.To design and test new clinical spaces, equipment, information technologies and procedures; 3. To practice and develop capability in individual and team performance; 4. To assess competency in complex clinical settings. CONCLUSIONS ISS presents a promising approach to improve individual and team capabilities and system performance and address the 'practice-theory gap'. However, there are limitations associated with ISS such as the impact on the clinical setting and service provision, the reliance of having an open learning culture and availability of relevant expertise. ISS should be introduced with due consideration of the specific objectives and learning needs it is proposed to address. Effectiveness of ISS has not yet been established and further research is required to evaluate and disseminate the findings of ISS interventions.
Collapse
Affiliation(s)
- Bryn Baxendale
- Trent Simulation & Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, Notts UK
| | - Kerry Evans
- Institute of Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Alison Cowley
- Nottingham University Hospitals NHS Trust, Research and Innovation, Nottingham, UK
| | - Louise Bramley
- Institute of Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Guilia Miles
- Trent Simulation & Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, Notts UK
| | - Alastair Ross
- Glasgow Dental School, University of Glasgow, Glasgow, UK
| | - Eleanore Dring
- Institute of Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Joanne Cooper
- Institute of Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK
| |
Collapse
|
10
|
Voillequin S, Rozenberg P, Ravaud P, Rousseau A. Promptness of oxytocin administration for first-line treatment of postpartum hemorrhage: a national vignette-based study among midwives. BMC Pregnancy Childbirth 2022; 22:353. [PMID: 35461215 PMCID: PMC9034651 DOI: 10.1186/s12884-022-04648-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide. Midwives play a key role in the initial management of PPH. Uterotonic agents are widely used in its prevention and treatment, with oxytocin the first-line agent. Nonetheless, a standardized guideline for optimal dose and rate of administration has not been clearly defined. The aim of this study was to investigate French midwives’ practices regarding first-line oxytocin treatment and the factors influencing its delayed administration. Methods This multicenter study was based on clinical vignettes of PPH management collected using an anonymous online questionnaire. A random sample of midwives from 145 maternity units in France from 15 randomly selected perinatal networks were invited to participate by email. The Previously validated case vignettes described two different scenarios of severe PPH. Vignette 1 described a typical immediate, severe PPH, and vignette 2 a less typical case of severe but gradual PPH They were constructed in three successive steps and included multiple-choice questions proposing several types of clinical practice options at each stage. For each vignette separately, we analyzed the lack of prompt oxytocin administration and the factors contributing to them, that is, characteristics of the midwives and organizational features of maternity units. Bivariate analysis and multivariable logistic regression analysis were applied. Results In all, 450 midwives from 87 maternity units provided complete responses. Lack of promptness was observed in 21.6% of responses (N = 97) in Vignette 1 and in 13.8% (N = 62) in Vignette 2 (p < .05). After multivariate analysis, the risk of delay was lower among with midwives working in university maternity hospitals (ORa 0.47, 95% 0.21, 0.97) and in units with 1500 to 2500 births per year (ORa 0.49, 95% CI 0.26, 0.90) for Vignette 1. We also noticed that delay increased with the midwives’ years of experience (per 10-year period) (ORa 1.30, 95% CI 1.01, 1.69). Conclusions This study using clinical vignettes showed delays in oxytocin administration for first-line treatment of PPH. Because delay in treatment is a major cause of preventable maternal morbidity in PPH, these findings suggest that continuing training of midwives should be considered, especially in small maternity units. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04648-5.
Collapse
Affiliation(s)
- S Voillequin
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France. .,INSERM UMR1018 "Clinical Epidemiology Team", Research Center on Epidemiology and Population Health (CESP), UVSQ, Paris Saclay University, Villejuif, France. .,Midwifery Department, Strasbourg University, Strasbourg, France.
| | - P Rozenberg
- INSERM UMR1018 "Clinical Epidemiology Team", Research Center on Epidemiology and Population Health (CESP), UVSQ, Paris Saclay University, Villejuif, France.,Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
| | - Ph Ravaud
- INSERM UMR1153, Centre of Research Epidemiology and Statistics (CRESS), Université de Paris, Paris, France.,Center for Clinical Epidemiology, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Paris, France
| | - A Rousseau
- INSERM UMR1018 "Clinical Epidemiology Team", Research Center on Epidemiology and Population Health (CESP), UVSQ, Paris Saclay University, Villejuif, France.,Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
| |
Collapse
|
11
|
Hathaway JR, Tarini BA, Banerjee S, Smolkin CO, Koos JA, Pati S. Healthcare team communication training in the United States: A scoping review. HEALTH COMMUNICATION 2022:1-26. [PMID: 35168467 DOI: 10.1080/10410236.2022.2036439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The purpose of this literature review was to identify interventions designed to improve healthcare team communication in the United States. We conducted a review of peer-reviewed, English-language articles describing interventions aimed at improving healthcare team communication. We analyzed articles that met pre-specified inclusion and exclusion criteria and characterized who is testing communication interventions, the rationale for testing, and ways of measuring effectiveness. We descriptively categorized the strength and types of study findings. Thirty articles were retained in our analysis. Most assessments were conducted by academic medical centers, the Veterans Health Administration, and teaching hospitals. Interventions sought to improve teamwork, patient safety, clinical outcomes, costs of care, and enhance provider job satisfaction and well-being. Intervention strategies included didactic lectures, simulation, Crew Resource Management, quality improvement, or a combination of these approaches. The vast majority employed a pre-post survey design and measured outcomes using participant feedback. Many assessments failed to utilize a social science theory or communication-specific measures. Interventions with the best training content were conducted at academic medical centers, used a pre-post design, and utilized statistical analysis to analyze results. While interventions for improving healthcare team communication are diverse and have uneven effectiveness, early markers of success merit continued development and assessment.
Collapse
Affiliation(s)
- Julia R Hathaway
- Alan Alda Center for Communicating Science®, Stony Brook University
| | - Beth A Tarini
- Center for Translational Research, Children's National Medical Center
| | - Sushmita Banerjee
- Renaissance School of Medicine, Stony Brook University, Stony Brook University
| | - Caroline O Smolkin
- Renaissance School of Medicine, Stony Brook University, Stony Brook University
| | | | - Susmita Pati
- Alan Alda Center for Communicating Science®, Renaissance School of Medicine at Stony Brook University & Stony Brook Children's Hospital, Stony Brook University
| |
Collapse
|
12
|
Maddan C, Forbes M, Campbell-Mitchell M, Rattray C, Bryan L. The Effect of Obstetric Drills Training - Jamaica Core Obstetric Teaching and Training in Emergencies (JOTTIE) on Postpartum Haemorrhage at a Jamaican Teaching Hospital. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2022; 9:23821205221076651. [PMID: 35155812 PMCID: PMC8829713 DOI: 10.1177/23821205221076651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate whether the initiation of JOTTIE, a one day simulation training course focussed on the management of common obstetric emergencies, was associated with a reduction in the morbidity and mortality associated with postpartum haemorrhage (PPH) at the University Hospital of the West Indies (UHWI). STUDY DESIGN We conducted a retrospective comparative study that evaluated the incidence of multiple outcomes related to maternal morbidity secondary to PPH, during the two year period immediately prior to the introduction of JOTTIE (pre course arm, N = 88) or the two year period, one year post introduction (post course arm, N = 103) for all women who had vaginal deliveries complicated by PPH at UHWI. A relationship was said to be statistically significant if p < 0.05. Additionally, the study examined risk factors in relation to severity of haemorrhage. RESULTS Genital tract trauma represented the highest recorded cause of PPH (approximately 71%). The data revealed that patients in the pre training arm were similarly likely to have no adverse outcome in comparison to patients in the post training arm (p = 0.962). There was also no statistically significant relationship between the time period of patient exposure in relation to the JOTTIE course and severity of PPH (p > 0.05). Uterine fibroids and Crohn's disease were the only co-morbidities found to increase the likelihood of severe PPH, at 5.154 times (p = 0.019,OR = 5.154, CI = 1.314-20.212) and 17.848 times (p = 0.085,OR = 17.848,CI = 0.672-474.365), respectively. CONCLUSIONS This study suggests that prior to the introduction of the JOTTIE the rate of maternal morbidity associated with PPH was relatively low at UHWI and there was no significant effect on its management or a significant reduction in maternal morbidity since introduction of the course. Future research on the morbidity related to the other obstetric emergencies addressed at JOTTIE is needed in order to assess the effect of the course as a whole.
Collapse
|
13
|
Gallagher G, Griffin A, Clipperton S, Janssens S. Impact of simulation training on decision to delivery interval in cord prolapse. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:543-547. [DOI: 10.1136/bmjstel-2021-000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 11/04/2022]
Abstract
BackgroundUmbilical cord prolapse is a rare obstetric emergency requiring rapid coordination of a multidisciplinary team to effect urgent delivery. The decision to delivery interval (DDI) is a marker of quality of teamwork. Multidisciplinary team simulation-based training can be used to improve clinical and teamwork performance.AimTo assess the DDI for cord prolapse before and after the introduction of simulation-based training at a quaternary maternity unit in Australia.MethodA retrospective, observational cohort study comparing the DDI before and after the introduction of simulation-based training activities. The general linear model was used to estimate the association between DDI and simulation training while adjusting for potential confounders including model of care (public or private) and time of birth (regular or after hours).ResultsAfter the introduction of simulation training, mean DDI decreased by 4.1 min (difference −4.1, 95% CI −6.2 to −1.9), after adjustment for confounding factors. Despite this, there was no difference in selected neonatal outcomes including Apgar score at 5 min and arterial cord pH.ConclusionsThe introduction of simulation-based training was associated with a decrease in the DDI in the setting of cord prolapse.
Collapse
|
14
|
Jafri FN, Mirante D, Ellsworth K, Shulman J, Dadario NB, Williams K, Yu S, Thomas J, Kumar A, Edwards RA, Torres RE, Straff DJ. A Microdebriefing Crisis Resource Management Program for Simulated Pediatric Resuscitation in a Community Hospital: A Feasibility Study. Simul Healthc 2021; 16:163-169. [PMID: 32842074 DOI: 10.1097/sih.0000000000000480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Crisis Resource Management (CRM) is a team training tool used in healthcare to enhance team performance and improve patient safety. Our program intends to determine the feasibility of high-fidelity simulation for teaching CRM to an interprofessional team in a community hospital and whether a microdebriefing intervention can improve performance during simulated pediatric resuscitation. METHODS We conducted a single-center prospective interventional study with 24 teams drawn from 4 departments. The program was divided into an initial assessment simulation case (pre), a 40-minute microdebriefing intervention, and a final assessment simulation case (post). Post and pre results were analyzed for each team using t tests and Wilcoxon signed-rank tests. Primary outcome measures included (a) completion of program, (b) percent enrollment, (c) participant reaction, and (d) support of continued programs on completion. Secondary outcomes included (a) change in teamwork performance, measured by the Clinical Teamwork Scale; (b) change in time to initiation of chest compressions and defibrillation; and (c) pediatric advanced life support adherence, measured by the Clinical Performance Tool. RESULTS We successfully completed a large-scale training program with high enrollment. Twenty-four teams with 162 participants improved in Clinical Teamwork Scale scores (42.8%-57.5%, P < 0.001), Clinical Performance Tool scores (61.7%-72.1%, P < 0.001), and time to cardiopulmonary resuscitation initiation (70.6-34.3 seconds, P < 0.001). CONCLUSIONS Our center ran a well-attended, well-received interprofessional program in a community hospital site demonstrating that teaching CRM skills can improve simulated team performance in a diverse experienced cohort.
Collapse
Affiliation(s)
- Farrukh N Jafri
- From the Albert Einstein College of Medicine (F.N.J., R.T., D.J.S.), New York City; Departments of Emergency Medicine (F.N.J., D.M., J.S., K.W., S.Y., J.T., R.T., D.J.S.) and Critical Care (K.E.), White Plains Hospital, White Plains; Integrative Neuroscience Binghamton University (N.D.), Binghamton; Department Ambulatory Surgery (S.Y.), White Plains Hospital, White Plains, NY; and MGH Institute of Health Professions (A.K., R.A.E.), Boston, MA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Hernández E, Camacho M, Leal-Costa C, Ruzafa-Martínez M, Ramos-Morcillo AJ, Cazorla E, Díaz-Agea JL. Does Multidisciplinary Team Simulation-Based Training Improve Obstetric Emergencies Skills? Healthcare (Basel) 2021; 9:healthcare9020170. [PMID: 33562857 PMCID: PMC7915121 DOI: 10.3390/healthcare9020170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 11/16/2022] Open
Abstract
Clinical simulation in obstetrics has turned out to be a tool that can reduce the rate of perinatal morbidity and mortality. The objective of this study was to analyze the impact and evaluate the effects of training with high-fidelity simulation of obstetric emergencies on a multidisciplinary group. The quasi-experimental research study was structured in three phases: a first phase where the most important obstetric emergencies were determined, a second phase of design and development of the selected cases for simulation training, and a third and final phase where the abilities and satisfaction of the multidisciplinary team were analyzed. Three scenarios and their respective evaluation tools of obstetric emergencies were selected for simulation training: postpartum hemorrhage, shoulder dystocia, and breech delivery. The health professionals significantly improved their skills after training, and were highly satisfied with the simulation experience (p < 0.05). An inter-observer agreement between good and excellent reliability was obtained. Regarding conclusions, we can state that high-fidelity obstetric emergency simulation training improved the competencies of the health professionals.
Collapse
Affiliation(s)
- Encarna Hernández
- Faculty of Nursing, Universidad Católica de Murcia (UCAM), Av. de los Jerónimos, 135, Guadalupe, 30107 Murcia, Spain; (E.H.); (J.L.D.-A.)
| | - Marcos Camacho
- Hospital of Huercal-Overa, Av. de la Dra. Ana Parra, s/n, Huércal-Overa, 04600 Almería, Spain
- Correspondence: (M.C.); (C.L.-C.)
| | - César Leal-Costa
- Faculty of Nursing, Universidad de Murcia (UM), Campus de Espinardo, 30100 Murcia, Spain; (M.R.-M.); (A.J.R.-M.)
- Correspondence: (M.C.); (C.L.-C.)
| | - María Ruzafa-Martínez
- Faculty of Nursing, Universidad de Murcia (UM), Campus de Espinardo, 30100 Murcia, Spain; (M.R.-M.); (A.J.R.-M.)
| | - Antonio Jesús Ramos-Morcillo
- Faculty of Nursing, Universidad de Murcia (UM), Campus de Espinardo, 30100 Murcia, Spain; (M.R.-M.); (A.J.R.-M.)
| | - Eduardo Cazorla
- Department of Obstetrics and Gynecology, Hospital de Torrevieja, Carretera CV 95, s/n, Torrevieja, 03186 Alicante, Spain;
| | - José Luis Díaz-Agea
- Faculty of Nursing, Universidad Católica de Murcia (UCAM), Av. de los Jerónimos, 135, Guadalupe, 30107 Murcia, Spain; (E.H.); (J.L.D.-A.)
| |
Collapse
|
16
|
Klumpner TT, Massarweh NN, Kheterpal S. Opportunities to Improve the Capacity to Rescue: Intraoperative and Perioperative Tools. Anesthesiol Clin 2020; 38:775-787. [PMID: 33127027 DOI: 10.1016/j.anclin.2020.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Postoperative complications, which occur in approximately 23% of surgeries, are a major source of patient mortality. Some of these deaths may be preventable. This article explores factors and contexts during the intraoperative period, in the postanesthesia care unit, perioperatively, and after discharge that may represent opportunities to intervene and prevent mortality after a potentially treatable complication. Tools to improve the identification and response to life-threatening complications in these unique care settings are discussed.
Collapse
Affiliation(s)
- Thomas T Klumpner
- Department of Anesthesiology, University of Michigan, 1H247 University Hospital, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5048, USA; Department of Obstetrics and Gynecology, University of Michigan, L4001 Women's Hospital, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0276, USA.
| | - Nader N Massarweh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey VAMC, 2002 Holcombe Boulevard, OCL 112, Houston, TX 77030, USA; Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Sachin Kheterpal
- Department of Anesthesiology, University of Michigan, 1H247 University Hospital, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5048, USA
| |
Collapse
|
17
|
DeStephano CC, Nitsche JF, Heckman MG, Banks E, Hur HC. ACOG Simulation Working Group: A Needs Assessment of Simulation Training in OB/GYN Residencies and Recommendations for Future Research. JOURNAL OF SURGICAL EDUCATION 2020; 77:661-670. [PMID: 31859227 DOI: 10.1016/j.jsurg.2019.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/29/2019] [Accepted: 12/01/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate current availability and needs of simulation training among obstetrics/gynecology (OB/GYN) residency programs. DESIGN Cross-sectional survey. SETTING Accreditation Council for Graduate Medical Education accredited OB/GYN residency programs in the United States. PARTICIPANTS Residency program directors, gynecology simulation faculty, obstetrics simulation faculty, and fourth-year residents. RESULTS Of 673 invited participants, 251 (37.3%) completed the survey. Among the survey responses, OB procedures were more broadly represented compared to the GYN procedures for simulation teaching: 8 (50%) of 16 OB procedures versus 4 (18.2%) of 22 GYN procedures had simulation teaching. Among the simulated procedures, a majority of residents and faculty reported that simulation teaching was available for operative vaginal delivery, postpartum hemorrhage, shoulder dystocia, perineal laceration repair, conventional laparoscopic procedures, and robotic surgery. There were significant differences between residents and faculty perceptions regarding the availability and needs of simulated procedures with a minority of residents having knowledge of Council on Resident Education in Obstetrics and Gynecology (47.2%) and American College of Obstetrics and Gynecology (27.8%) simulation tools compared to the majority of faculty (84.7% and 72.1%, respectively). More than 80% of trainees and faculty reported they felt the average graduating resident could perform vaginal, laparoscopic, and abdominal hysterectomies independently. CONCLUSIONS Simulation is now widely available for both gynecologic and obstetric procedures, but there remains tremendous heterogeneity between programs and the perceptions of residents, program directors, and faculty. The variations in simulation training and readiness for performing different procedures following residency support the need for objective, validated assessments of actual performance to better guide resident learning and faculty teaching efforts.
Collapse
Affiliation(s)
| | - Joshua F Nitsche
- Wake Forest School of Medicine Department of OB/GYN, Winston-Salem, North Carolina
| | - Michael G Heckman
- Mayo Clinic Department of Surgical Gynecology, Jacksonville, Florida; Mayo Clinic Division of Biomedical Statistics and Informatics, Jacksonville, Florida
| | - Erika Banks
- Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, New York, New York
| | - Hye-Chun Hur
- Division of Gynecologic Specialty Surgery, Department of Obstetrics and Gynecology, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York
| |
Collapse
|
18
|
Benefits of Screen-Based Postpartum Hemorrhage Simulation on Nontechnical Skills Training: A Randomized Simulation Study. Simul Healthc 2020; 14:391-397. [PMID: 31804424 DOI: 10.1097/sih.0000000000000395] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postpartum hemorrhage (PPH) is the leading cause of maternal death in the world. Nontechnical skills (NTS), such as communication and teamwork, are critical for efficient management of this obstetric emergency. Specific scenarios were designed on a screen-based simulator to train NTS. This study aimed to evaluate the impact of training midwives for NTS with a PPH screen-based simulation. METHODS A total of 24 midwives participated in the study. They were randomized in 2 groups: the NTS group (n = 12) performed 3 screen-based scenarios designed to train NTS and the control group (n = 12) performed 3 basic scenarios of the screen-based simulation without the NTS training. A structured interview followed the simulation. On the same day, each trainee underwent individually an evaluation on a PPH high-fidelity simulation scenario. Three experts, blinded to the study arm, assessed the NTS with the Anesthetists Non-Technical Skills (ANTS) score. RESULTS Midwives from the NTS group achieved higher median scores in each dimension of the ANTS score: task management (4 vs. 2/4, P < 0.0001), team working (4 vs. 2/4, P < 0.0001), situation awareness (4 vs. 2.7/4, P < 0.0001), and decision-making (4 vs. 2/4, P < 0.0001). The median value of the total ANTS score was higher in the NTS group than in the control group (15.5 vs. 8/16, P < 0.0001). CONCLUSIONS Our study highlights that training with a NTS screen-based simulation, with specific scenarios and debriefing, leads to higher midwives' nontechnical skills performance during simulated postpartum hemorrhage.
Collapse
|
19
|
Walsh BM, Auerbach MA, Gawel MN, Brown LL, Byrne BJ, Calhoun A. Community-based in situ simulation: bringing simulation to the masses. Adv Simul (Lond) 2019; 4:30. [PMID: 31890313 PMCID: PMC6925415 DOI: 10.1186/s41077-019-0112-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
Simulation-based methods are regularly used to train inter-professional groups of healthcare providers at academic medical centers (AMC). These techniques are used less frequently in community hospitals. Bringing in-situ simulation (ISS) from AMCs to community sites is an approach that holds promise for addressing this disparity. This type of programming allows academic center faculty to freely share their expertise with community site providers. By creating meaningful partnerships community-based ISS facilitates the communication of best practices, distribution of up to date policies, and education/training. It also provides an opportunity for system testing at the community sites. In this article, we illustrate the process of implementing an outreach ISS program at community sites by presenting four exemplar programs. Using these exemplars as a springboard for discussion, we outline key lessons learned discuss barriers we encountered, and provide a framework that can be used to create similar simulation programs and partnerships. It is our hope that this discussion will serve as a foundation for those wishing to implement community-based, outreach ISS.
Collapse
Affiliation(s)
- Barbara M Walsh
- 1Department of Pediatrics, Division of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, 818 Harrison Ave, Vose 5, Boston, MA 02118 USA
| | - Marc A Auerbach
- 2Department of Pediatrics, Yale University School of Medicine, New Haven, USA
| | | | - Linda L Brown
- 4Department of Pediatrics and Emergency Medicine, Alpert Medical School of Brown University, Providence, USA
| | - Bobbi J Byrne
- 5Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA
| | - Aaron Calhoun
- 6Department of Pediatrics, University of Louisville School of Medicine, Louisville, USA
| | | |
Collapse
|
20
|
|
21
|
Ameh CA, Mdegela M, White S, van den Broek N. The effectiveness of training in emergency obstetric care: a systematic literature review. Health Policy Plan 2019; 34:257-270. [PMID: 31056670 PMCID: PMC6661541 DOI: 10.1093/heapol/czz028] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2019] [Indexed: 12/19/2022] Open
Abstract
Providing quality emergency obstetric care (EmOC) reduces the risk of maternal and newborn mortality and morbidity. There is evidence that over 50% of maternal health programmes that result in improving access to EmOC and reduce maternal mortality have an EmOC training component. The objective was to review the evidence for the effectiveness of training in EmOC. Eleven databases and websites were searched for publications describing EmOC training evaluations between 1997 and 2017. Effectiveness was assessed at four levels: (1) participant reaction, (2) knowledge and skills, (3) change in behaviour and clinical practice and (4) availability of EmOC and health outcomes. Weighted means for change in knowledge and skills obtained, narrative synthesis of results for other levels. One hundred and one studies including before-after studies (n = 44) and randomized controlled trials (RCTs) (n = 15). Level 1 and/or 2 was assessed in 68 studies; Level 3 in 51, Level 4 in 21 studies. Only three studies assessed effectiveness at all four levels. Weighted mean scores pre-training, and change after training were 67.0% and 10.6% for knowledge (7750 participants) and 53.1% and 29.8% for skills (6054 participants; 13 studies). There is strong evidence for improved clinical practice (adherence to protocols, resuscitation technique, communication and team work) and improved neonatal outcomes (reduced trauma after shoulder dystocia, reduced number of babies with hypothermia and hypoxia). Evidence for a reduction in the number of cases of post-partum haemorrhage, case fatality rates, stillbirths and institutional maternal mortality is less strong. Short competency-based training in EmOC results in significant improvements in healthcare provider knowledge/skills and change in clinical practice. There is emerging evidence that this results in improved health outcomes.
Collapse
Affiliation(s)
- Charles A Ameh
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Mselenge Mdegela
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Sarah White
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| |
Collapse
|
22
|
Raimann FJ, Jennewein L, Sonntagbauer M, Raddatz LM, Möllmann CJ, Louwen F, Zacharowski K, Weber CF. Influence of the WOMAN trial on national wide standard operating procedures for treatment of postpartum hemorrhage. J Gynecol Obstet Hum Reprod 2019; 48:269-273. [DOI: 10.1016/j.jogoh.2019.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 12/21/2022]
|
23
|
Cacciola TP, Martino M. Simulation in Obstetrics and Gynecology. COMPREHENSIVE HEALTHCARE SIMULATION: SURGERY AND SURGICAL SUBSPECIALTIES 2019. [DOI: 10.1007/978-3-319-98276-2_30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
24
|
Evaluating Adherence to Guideline-Based Quality Indicators for Postpartum Hemorrhage Care in the Netherlands Using Video Analysis. Obstet Gynecol 2018; 132:656-667. [DOI: 10.1097/aog.0000000000002781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
25
|
A Simulation-Based Quality Improvement Initiative Improves Pediatric Readiness in Community Hospitals. Pediatr Emerg Care 2018; 34:431-435. [PMID: 28719479 DOI: 10.1097/pec.0000000000001233] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The National Pediatric Readiness Project Pediatric Readiness Survey (PRS) measured pediatric readiness in 4149 US emergency departments (EDs) and noted an average score of 69 on a 100-point scale. This readiness score consists of 6 domains: coordination of pediatric patient care (19/100), physician/nurse staffing and training (10/100), quality improvement activities (7/100), patient safety initiatives (14/100), policies and procedures (17/100), and availability of pediatric equipment (33/100). We aimed to assess and improve pediatric emergency readiness scores across Connecticut's hospitals. OBJECTIVE The aim of this study was to compare the National Pediatric Readiness Project readiness score before and after an in situ simulation-based assessment and quality improvement program in Connecticut hospitals. METHODS We leveraged in situ simulations to measure the quality of resuscitative care provided by interprofessional teams to 3 simulated patients (infant septic shock, infant seizure, and child cardiac arrest) presenting to their ED resuscitation bay. Assessments of EDs were made based on a composite quality score that was measured as the sum of 4 distinct domains: (1) adherence to sepsis guidelines, (2) adherence to cardiac arrest guidelines, (3) performance on seizure resuscitation, and (4) teamwork. After the simulation, a detailed report with scores, comparisons to other EDs, and a gap analysis were provided to sites. Based on this report, a regional children's hospital team worked collaboratively with each ED to develop action items and a timeline for improvements. The National Pediatric Readiness Project PRS scores, the primary outcome of this study, were measured before and after participation. RESULTS Twelve community EDs in Connecticut participated in this project. The PRS scores were assessed before and after the intervention (simulation-based assessment and gap analysis/report-out). The average time between PRS assessments was 21 months. The PRS scores significantly improved 12.9% from the first assessment (mean ± SEM = 64 ± 4.4) to the second assessment (77 ± 4.0, P = 0.022). The PRS score domains also showed improvements in coordination of pediatric patient care (median improvement, 50%), quality improvement activities (median improvement, 79%), patient safety initiatives (mean improvement, 7%), policies and procedures (mean improvement, 17%), and availability of pediatric equipment (mean improvement, 7%). CONCLUSIONS Participation in a simulation-based quality improvement collaborative was associated with improvements in pediatric readiness.
Collapse
|
26
|
Interdisciplinary Skills Review Program to Improve Team Responses During Postpartum Hemorrhage. J Obstet Gynecol Neonatal Nurs 2017; 47:254-263. [PMID: 29080398 DOI: 10.1016/j.jogn.2017.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To develop an interdisciplinary, interactive, skills review program to improve team responses during a postpartum hemorrhage (PPH). DESIGN Online didactic modules in combination with an interdisciplinary skills program consisting of seven hemorrhage-related stations. SETTING/LOCAL PROBLEM The project was conducted in the Women's Health Department in a quaternary-care Magnet- and Baby Friendly-designated academic medical center in Philadelphia, Pennsylvania. Women cared for at this center have comorbidities that place them at greater risk for PPH. A need was identified to implement a multidisciplinary and comprehensive program to assess hemorrhage risk and appropriately recognize and intervene with all PPHs in this setting. PARTICIPANTS The 276 participants, including registered nurses, obstetric and family medicine attending physicians and residents, advanced practice nurses, and ancillary staff in the hospital's Women's Health Department, completed the initial obstetric hemorrhage program. INTERVENTION/MEASUREMENTS The program included online didactic modules, seven interdisciplinary skills stations led by trained nurses and providers, and an in situ simulation. Successful completion of the online modules was a prerequisite for participation in the skills stations. All participants completed a written program evaluation at the conclusion of the program. RESULTS Results of the postassessment survey indicated that participants rated the program 3.94 of 4.00 for overall effectiveness to improve interdisciplinary team responses to PPH. Comments were overwhelmingly positive, and participants expressed increased confidence and knowledge related to PPH after completion of the program. CONCLUSION An interdisciplinary program that included online didactic modules, interactive skills stations, and simulation improved team confidence and responses to PPH.
Collapse
|
27
|
Egenberg S, Masenga G, Bru LE, Eggebø TM, Mushi C, Massay D, Øian P. Impact of multi-professional, scenario-based training on postpartum hemorrhage in Tanzania: a quasi-experimental, pre- vs. post-intervention study. BMC Pregnancy Childbirth 2017; 17:287. [PMID: 28874123 PMCID: PMC5584507 DOI: 10.1186/s12884-017-1478-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/30/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Tanzania has a relatively high maternal mortality ratio of 410 per 100,000 live births. Severe postpartum hemorrhage (PPH) is a major cause of maternal deaths, but in most cases, it is preventable. However, most pregnant women that develop PPH, have no known risk factors. Therefore, preventive measures must be offered to all pregnant women. This study investigated the effects of multi-professional, scenario-based training on the prevention and management of PPH at a Tanzanian zonal consultant hospital. We hypothesized that scenario-based training could contribute to improved competence on PPH-management, which would result in improved team efficiency and patient outcome. METHODS This quasi-experimental, pre-vs. post-interventional study involved on-site multi-professional, scenario-based PPH training, conducted in a two-week period in October 2013 and another 2 weeks in November 2014. Training teams included nurses, midwives, doctors, and medical attendants in the Department of Obstetrics and Gynecology. After technical skill training on the birthing simulator MamaNatalie®, the teams practiced in realistic scenarios on PPH. Each scenario was followed by debriefing and repeated scenario. Afterwards, the group swapped roles and the observers became the participants. To evaluate the effects of training, we measured patient outcomes by determining blood transfusion rates. Patient data were collected by randomly sampling Medical birth registry files from the pre-training and post-training study periods (n = 1667 and 1641 files, respectively). Data were analyzed with the Chi-square test, Mann-Whitney U-test, and binary logistic regression. RESULTS The random patient samples (n = 3308) showed that, compared to pre-training, post-training patients had a 47% drop in whole blood transfusion rates and significant increases in cesarean section rates, birth weights, and vacuum deliveries. The logistic regression analysis showed that transfusion rates were significantly associated with the time period (pre- vs. post-training), cesarean section, patients tranferred from other hospitals, maternal age, and female genital mutilation and cutting. CONCLUSIONS We found that multi-professional, scenario-based training was associated with a significant, 47% reduction in whole blood transfusion rates. These results suggested that training that included all levels of maternity staff, repeated sessions with realistic scenarios, and debriefing may have contributed to reduced blood transfusion rates in this high-risk maternity setting.
Collapse
Affiliation(s)
- Signe Egenberg
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Gerd-Ragna Bloch Thorsens gate 8, 4011, Stavanger, Norway.
| | - Gileard Masenga
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Lars Edvin Bru
- Center for Behavioral Research, University of Stavanger, Stavanger, Norway
| | - Torbjørn Moe Eggebø
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Gerd-Ragna Bloch Thorsens gate 8, 4011, Stavanger, Norway
- National Center for Fetal Medicine, Trondheim University Hospital, Trondheim, Norway
| | - Cecilia Mushi
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Pål Øian
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
| |
Collapse
|
28
|
Egenberg S, Karlsen B, Massay D, Kimaro H, Bru LE. "No patient should die of PPH just for the lack of training!" Experiences from multi-professional simulation training on postpartum hemorrhage in northern Tanzania: a qualitative study. BMC MEDICAL EDUCATION 2017; 17:119. [PMID: 28705158 PMCID: PMC5512986 DOI: 10.1186/s12909-017-0957-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 06/27/2017] [Indexed: 05/18/2023]
Abstract
BACKGROUND Postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality. In Tanzania, PPH causes 25% of maternal deaths. Skilled attendance is crucial to saving the lives of mothers and their newborns during childbirth. This study is a follow-up after multi-professional simulation training on PPH in northern Tanzania. The purpose was to enhance understanding and gain knowledge of important learning features and outcomes related to multi-professional simulation training on PPH. METHODS The study had a descriptive and exploratory design. After the second annual simulation training at two hospitals in northern Tanzania, ten focus group discussions comprising 42 nurse midwives, doctors, and medical attendants, were carried out. A semi-structured interview guide was used during the discussions, which were audio-taped for qualitative content analysis of manifest content. RESULTS The most important findings from the focus group discussions were the importance of team training as learning feature, and the perception of improved ability to use a teamwork approach to PPH. Regardless of profession and job tasks, the informants expressed enhanced self-efficacy and reduced perception of stress. The informants perceived that improved competence enabled them to provide efficient PPH management for improved maternal health. They recommended simulation training to be continued and disseminated. CONCLUSION Learning features, such as training in teams, skills training, and realistic repeated scenarios with consecutive debriefing for reflective learning, including a systems approach to human error, were crucial for enhanced teamwork. Informants' confidence levels increased, their stress levels decreased, and they were confident that they offered better maternal services after training.
Collapse
Affiliation(s)
- Signe Egenberg
- RN/M PHD, Department of Obstetrics and Gynecology, Stavanger University Hospital, Armauer Hansensv. 20, 4011 Stavanger, Norway
| | - Bjørg Karlsen
- Professor, Department of Health Studies, University of Stavanger, Stavanger, Norway
| | | | - Happiness Kimaro
- RN/M, Children’s Department, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Lars Edvin Bru
- Professor, Department of Health Studies, University of Stavanger, Stavanger, Norway
| |
Collapse
|
29
|
|
30
|
The Effects of Abdominal Binder on Wound Healing and Consumed Pain Medications After Cesarean Section: A Randomized Control Trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2017. [DOI: 10.5812/ircmj.44119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
31
|
Farrar Highfield ME, Scharf-Swaller C, Chu L. Effect of Nurse-Led Review Plus Simulation on Obstetric/Perinatal Nurses' Self-Assessed Knowledge and Confidence. Nurs Womens Health 2016; 20:568-581. [PMID: 27938797 DOI: 10.1016/j.nwh.2016.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/18/2016] [Indexed: 11/25/2022]
Abstract
Simulation may help both novice and experienced clinicians maintain competence in managing high-risk, low-frequency obstetric and perinatal complications and emergencies. Therefore, we designed a pre-/posttest study to determine whether a day of nurse-led lecture plus low-fidelity simulation would increase registered nurses' self-assessed knowledge and confidence in managing five high-risk obstetric/perinatal situations. The Nursing Management of OB/Perinatal Complications & Emergencies (NursOB) scale was distributed to 67 labor/birth and postpartum nurses before and after a simulation training day. Preliminary findings supported validity and reliability of the NursOB scale, but nurses' knowledge and confidence did not improve after the simulation (p < .05). Anecdotally, nurses' interest in competence reviews was reinvigorated, and we gained practical knowledge in simulation delivery. Future simulations could enhance outcome measures, improve drills, and establish criterion-related validity of the NursOB scale. More research is warranted.
Collapse
|
32
|
Gelber SE, Grünebaum A, Chervenak FA. Reducing health care disparities: a call to action. Am J Obstet Gynecol 2016; 215:140-2. [PMID: 27397627 DOI: 10.1016/j.ajog.2016.06.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/28/2016] [Indexed: 01/09/2023]
Affiliation(s)
- Shari E Gelber
- Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY.
| | - Amos Grünebaum
- Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY
| | - Frank A Chervenak
- Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY
| |
Collapse
|
33
|
Nathan LM, Patauli D, Nsabimana D, Bernstein PS, Rulisa S, Goffman D. Retention of skills 2 years after completion of a postpartum hemorrhage simulation training program in rural Rwanda. Int J Gynaecol Obstet 2016; 134:350-3. [PMID: 27262941 DOI: 10.1016/j.ijgo.2016.01.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 01/08/2016] [Accepted: 05/06/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the long-term retention of skills gained by rural physicians who completed a postpartum hemorrhage simulation-training program. METHODS A quasi-experimental pre-post intervention study enrolled a convenience sample of generalist physicians in rural Rwanda. Participants underwent initial simulation training including pre- and post-training testing in February 2012. Simulation drills to assess skill retention were conducted in March 2014. Participants were scored based on their communication, evaluation, and management skills. Median scores and inter-quartile ranges were calculated and the Wilcoxon signed-rank sum test was used to compare the pre-training, post-training, and retention scores. Physician confidence was assessed using a survey. RESULTS In total, 11 physicians were enrolled; eight were available for the 2-year skill-retention evaluation. Significant improvements were observed when comparing participants' pre-training and post-training communication (P=0.03), evaluation (P=0.05), and management (P=0.02) scores, and there were no changes between participants' post-training and 2-year communication (P>0.99), evaluation (P=0.16), and management (P=0.46) scores. There were no differences in the self-reported confidence measures across the duration of the study. CONCLUSION Simulation training is an effective method for teaching postpartum hemorrhage-management skills to generalist physicians in rural areas and skills are retained for at least 2 years. Further studies could determine the optimal time intervals for refresher training.
Collapse
Affiliation(s)
- Lisa M Nathan
- Department of Obstetrics and Gynecology and Women's Health, Division of Maternal Fetal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
| | | | | | - Peter S Bernstein
- Department of Obstetrics and Gynecology and Women's Health, Division of Maternal Fetal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Stephen Rulisa
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, University of Rwanda; Department of Clinical Research, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Dena Goffman
- Department of Obstetrics and Gynecology and Women's Health, Division of Maternal Fetal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| |
Collapse
|
34
|
Kessler DO, Walsh B, Whitfill T, Dudas RA, Gangadharan S, Gawel M, Brown L, Auerbach M. Disparities in Adherence to Pediatric Sepsis Guidelines across a Spectrum of Emergency Departments: A Multicenter, Cross-Sectional Observational In Situ Simulation Study. J Emerg Med 2015; 50:403-15.e1-3. [PMID: 26499775 DOI: 10.1016/j.jemermed.2015.08.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/14/2015] [Accepted: 08/08/2015] [Indexed: 01/30/2023]
Abstract
BACKGROUND Each year in the United States, 72,000 pediatric patients develop septic shock, at a cost of $4.8 billion. Adherence to practice guidelines can significantly reduce mortality; however, few methods to compare performance across a spectrum of emergency departments (EDs) have been described. OBJECTIVES We employed standardized, in situ simulations to measure and compare adherence to pediatric sepsis guidelines across a spectrum of EDs. We hypothesized that pediatric EDs (PEDs) would have greater adherence to the guidelines than general EDs (GEDs). We also explored factors associated with improved performance. METHODS This multi-center observational study examined in situ teams caring for a simulated infant in septic shock. The primary outcome was overall adherence to the pediatric sepsis guideline as measured by six subcomponent metrics. Characteristics of teams were compared using multivariable logistic regression to describe factors associated with improved performance. RESULTS We enrolled 47 interprofessional teams from 24 EDs. Overall, 21/47 teams adhered to all six sepsis metrics (45%). PEDs adhered to all six metrics more than GEDs (93% vs. 22%; difference 71%, 95% confidence interval [CI] 43-84). Adherent teams had significantly higher Emergency Medical Services for Children readiness scores, MD composition of physicians to total team members, teamwork scores, provider perceptions of pediatric preparedness, and provider perceptions of sepsis preparedness. In a multivariable regression model, only greater composite team experience had greater adjusted odds of achieving an adherent sepsis score (adjusted odds ratio 1.38, 95% CI 1.01-1.88). CONCLUSIONS Using standardized in situ scenarios, we revealed high variability in adherence to the pediatric sepsis guideline across a spectrum of EDs. PEDs demonstrated greater adherence to the guideline than GEDs; however, in adjusted analysis, only composite team experience level of the providers was associated with improved guideline adherence.
Collapse
Affiliation(s)
- David O Kessler
- Department of Pediatrics, Columbia University Medical Center, New York Presbyterian Morgan Stanley Children's Hospital of New York, New York, New York
| | - Barbara Walsh
- Department of Pediatrics, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
| | - Travis Whitfill
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Robert A Dudas
- Department of Pediatrics, Johns Hopkins University, St. Petersburg, Florida
| | - Sandeep Gangadharan
- Department of Pediatrics, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Marcie Gawel
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Linda Brown
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island; Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Marc Auerbach
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | | |
Collapse
|
35
|
Kozhimannil KB, Casey MM, Hung P, Han X, Prasad S, Moscovice IS. The Rural Obstetric Workforce in US Hospitals: Challenges and Opportunities. J Rural Health 2015; 31:365-72. [PMID: 25808202 DOI: 10.1111/jrh.12112] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to describe the types and combinations of clinicians who are delivering babies in rural hospitals, their employment status, the relationship between hospital birth volume and staffing models, and the staffing challenges faced by rural hospitals. METHODS We conducted a telephone survey of 306 rural hospitals in 9 states: Colorado, Iowa, Kentucky, New York, North Carolina, Oregon, Vermont, Washington, and Wisconsin, from November 2013 to March 2014 to assess their obstetric workforce. Bivariate associations between hospitals' annual birth volume and obstetric workforce characteristics were examined, as well as qualitative analysis of workforce changes and staffing challenges. FINDINGS Hospitals with lower birth volume (<240 births per year) are more likely to have family physicians and general surgeons attending deliveries, while those with a higher birth volume more frequently have obstetricians and midwives attending deliveries. Reported staffing challenges include scheduling, training, census fluctuation, recruitment and retention, and intrahospital relationships. CONCLUSIONS Individual hospitals working in isolation may struggle to address staffing challenges. Federal and state policy makers, regional collaboratives, and health care delivery systems can facilitate solutions through programs such as telehealth, simulation training, and interprofessional education.
Collapse
Affiliation(s)
- Katy B Kozhimannil
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Michelle M Casey
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Peiyin Hung
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Xinxin Han
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Shailendra Prasad
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota.,Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Ira S Moscovice
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
36
|
Fahey JO. The Recognition and Management of Intrapartum Fetal Heart Rate Emergencies: Beyond Definitions and Classification. J Midwifery Womens Health 2014; 59:616-623. [DOI: 10.1111/jmwh.12256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|