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Alrhim RA, Najjar S, Smerat S. Obstetric Safety and Quality at Istishari Arab Hospital: Where Are We Now and How Can We Improve. EUROPEAN JOURNAL OF MEDICAL AND HEALTH SCIENCES 2022; 4:33-40. [DOI: 10.24018/ejmed.2022.4.1.1081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Background: Indicators for tracking progress in maternal and newborn health have been recommended by a number of global monitoring initiatives. Quality of care is increasingly recognized as an important aspect of maternal and newborn health, particularly in the labor and delivery and immediate postnatal period.
Objectives: The purpose of this study is to estimate the frequency of obstetric complications. Furthermore, in 2018, Istishari Arab Hospital assessed the safety and quality of obstetrical procedures. Identifying risk factors that contributed to adverse events in the obstetric department.
Methods: A retrospective study is dependent on the use of electronic medical records from inpatient hospitals. Research was conducted in the field of inquiry in an electronic database, as well as related studies. Maternal morbidity and adverse outcomes were identified using diagnosis and procedure codes from the International Classification of Diseases, 10th Revision (ICD-10-CM) within the health information system. Aside from the paper files. SPSS was used for descriptive, univariate, and multivariate analysis.
Results This study included 418 women, with 62.2 percent of them having their babies delivered by CS. The average age of the women in this study was 27.84.8 years, with 58.1 percent of them coming from Ramallah. Following a multivariate analysis using logistic regression, our study discovered a positive correlation with P-value 0.05 between educational level and prior CS on one side and surgical site infection on the other. Furthermore, our study found a link between the rate of CS on one side and maternal age, diabetes, hypertension, and gynecological factors on the other (prematurity, multiple gestation).
Conclusion: Regardless of the number, patients with a lower education level or a history of CS have a higher risk of surgical site infection and other complications. By focusing on these factors and increasing awareness and education, we may be able to reduce obstetric complications in the future.
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Garmi G, Pollig M, Inbar S, Fux S, Romano S, Salim R. Implementing military aviation debriefing methods to improve outcome of peripartum interventional procedures. Eur J Obstet Gynecol Reprod Biol 2020; 245:216-217. [PMID: 31892436 DOI: 10.1016/j.ejogrb.2019.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 12/11/2019] [Accepted: 12/23/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Gali Garmi
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Michael Pollig
- Shamaym Social Business, Hospital & Health Care Division, Tel Aviv, Israel
| | - Shiri Inbar
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Shalva Fux
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Shabtai Romano
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Raed Salim
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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Al Nadabi W, McIntosh B, McClelland T, Mohammed M. Patient safety culture in maternity units: a review. Int J Health Care Qual Assur 2019; 32:662-676. [PMID: 31111777 DOI: 10.1108/ijhcqa-01-2018-0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to summarize studies that have examined patient safety culture in maternity units and describe the different purposes, study designs and tools reported in these studies while highlighting gaps in the literature. DESIGN/METHODOLOGY/APPROACH Peer-reviewed studies, published in English during 1961-2016 across eight electronic databases, were subjected to a narrative literature review. FINDINGS Among 100 articles considered, 28 met the inclusion criteria. The main purposes for studying PSC were: assessing intervention effects on PSC (n=17), and assessing PSC level (n=7). Patient safety culture was mostly assessed quantitatively using validated questionnaires (n=23). The Safety Attitude Questionnaire was the most commonly used questionnaire (n=17). Interventions varied from a single action lasting five weeks to a more comprehensive four year package. The time between baseline and follow-up assessment varied from 6 to 24 months. No study reported measurement or intervention costs, and none incorporated the patient's voice in assessing PSC. PRACTICAL IMPLICATIONS Assessing PSC in maternity units is feasible using validated questionnaires. Interventions to enhance PSC have not been rigorously evaluated. Future studies should report PSC measurement costs, adopt more rigorous evaluation designs and find ways to incorporate the patient's voice. ORIGINALITY/VALUE This review summarized studies examining PSC in a highly important area and highlighted main limitations that future studies should consider.
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Affiliation(s)
- Waleed Al Nadabi
- School of Nursing and Healthcare Leadership, University of Bradford , Bradford, UK
| | - Bryan McIntosh
- School of Nursing and Healthcare Leadership, University of Bradford , Bradford, UK
| | - Tracy McClelland
- School of Nursing and Healthcare Leadership, University of Bradford , Bradford, UK
| | - Mohammed Mohammed
- Bradford Institute of Health Research, University of Bradford , Bradford, UK
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Reszel J, Weiss D, Sprague AE, Fell DB, Dunn S, Walker MC, Sidney D, Taljaard M, Peterson WE. A mixed-methods evaluation of the MORE OB program in Ontario hospitals: participant knowledge, organizational culture, and experiences. BMC Health Serv Res 2019; 19:460. [PMID: 31286979 PMCID: PMC6615285 DOI: 10.1186/s12913-019-4224-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 06/06/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND MOREOB (Managing Obstetrical Risk Efficiently) is a patient safety program for health care providers and administrators in hospital obstetric units. MOREOB has been implemented widely in Canada and gradually spread to the United States. The main goal of MOREOB is to build a patient safety culture and improve clinical outcomes. In 2013, 26 Ontario hospitals voluntarily accepted provincial funding to participate in MOREOB. The purpose of our study was to assess the effect of MOREOB on participant knowledge, organizational culture, and experiences implementing and participating in the program at these 26 Ontario hospitals. METHODS A convergent parallel mixed-methods study in Ontario, Canada, with MOREOB participants from 26 hospitals. The quantitative component used a descriptive pre-post repeated measures design to assess participant knowledge and perception of culture, administered pre-MOREOB and after each of the three MOREOB modules. Changes in mean scores were assessed using mixed-effects regression. The qualitative component used a qualitative descriptive design with individual semi-structured interviews. We used content analysis to code, categorize, and thematically describe data. A convergent parallel design was used to triangulate findings from data sources. RESULTS 308 participants completed the knowledge test, and 329 completed the culture assessment at all four time points. Between baseline and post-Module 3, statistically significant increases on both scores were observed, with an increase of 7.9% (95% CI: 7.1 to 8.8) on the knowledge test and an increase of 0.45 (on a scale of 1-5, 95% CI: 0.38 to 0.52) on the culture assessment. Interview participants (n = 15) described improvements in knowledge, interprofessional communication, ability to provide safe care, and confidence in skills. Facilitators and barriers to program implementation and sustainability were identified. CONCLUSIONS Participants were satisfied with their participation in the MOREOB program and perceived that it increased health care provider knowledge and confidence, improved safety for patients, and improved communication between team members. Additionally, mean scores on knowledge tests for obstetric content and culture assessment improved. The MOREOB program can help organizations and individuals improve care by concentrating on the human and organizational aspects of patient safety. Further work to improve program implementation and sustainability is required.
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Affiliation(s)
- Jessica Reszel
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada
- Children’s Hospital of Eastern Ontario (CHEO) Research Institute, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada
| | - Deborah Weiss
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada
- School of Epidemiology and Public Health, University of Ottawa , 600 Peter Morand Crescent, Ottawa, Ontario K1G 5Z3 Canada
| | - Ann E. Sprague
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada
- Children’s Hospital of Eastern Ontario (CHEO) Research Institute, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada
| | - Deshayne B. Fell
- Children’s Hospital of Eastern Ontario (CHEO) Research Institute, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada
- School of Epidemiology and Public Health, University of Ottawa , 600 Peter Morand Crescent, Ottawa, Ontario K1G 5Z3 Canada
| | - Sandra Dunn
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada
- Children’s Hospital of Eastern Ontario (CHEO) Research Institute, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada
| | - Mark C. Walker
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada
- School of Epidemiology and Public Health, University of Ottawa , 600 Peter Morand Crescent, Ottawa, Ontario K1G 5Z3 Canada
- Clinical Epidemiology, Ottawa Hospital Research Institute (OHRI), 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
- Department of Obstetrics and Gynecology, University of Ottawa , 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
| | - Dana Sidney
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa , 600 Peter Morand Crescent, Ottawa, Ontario K1G 5Z3 Canada
- Clinical Epidemiology, Ottawa Hospital Research Institute (OHRI), 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
| | - Wendy E. Peterson
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5 Canada
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Pharmacists' attitudes, knowledge, utilization, and outcomes involving prescription drug monitoring programs: A brief scoping review. J Am Pharm Assoc (2003) 2018; 58:568-576. [DOI: 10.1016/j.japh.2018.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/29/2018] [Accepted: 06/03/2018] [Indexed: 02/07/2023]
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Santos P, Joglekar A, Faughnan K, Darden J, Masters L, Hendrich A, McCoy CK. Sustaining and spreading quality improvement: Decreasing intrapartum malpractice risk. J Healthc Risk Manag 2018; 38:42-50. [PMID: 30144213 DOI: 10.1002/jhrm.21329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Malpractice liability is an ongoing problem in obstetrics. However, developing, sustaining, and spreading effective interventions is challenging. The aim of this study is to examine the spread and sustainability of a multilevel integrated practice and coordinated communication model 66 months after its original implementation. METHODS Data on labor and delivery patients from 37 hospitals (5 beta sites and 32 expansion sites) were analyzed for the 81-month time period from January 2010 through September 2016. RESULTS High-risk occurrence rates per 1000 live births decreased by over 70% at both beta and expansion sites. The likelihood of a high-risk occurrence was statistically significantly lower during the final study period than in the preintervention period at both beta sites (odds ratio [OR] = 0.218; p < .0001) and expansion sites (OR = 0.288; p < .001). CONCLUSION The multilevel integrated practice and coordinated communication model was successfully spread and sustained. Key elements contributing to this success included developing and maintaining evidence-based guidelines, ensuring leadership buy-in and support, collecting and reporting performance measures, holding teams accountable, providing training, and ensuring transparent communication.
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Affiliation(s)
- Palmira Santos
- Brandeis University's Institute on Healthcare Systems, Waltham, MA
| | - Anju Joglekar
- Brandeis University's Schneider Institutesfor Health Policy, Waltham, MA
| | - Kristen Faughnan
- Brandeis University's Institute on Healthcare Systems, Waltham, MA
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Sabol B, Caughey AB. Quality Improvement and Patient Safety on Labor and Delivery. Obstet Gynecol Clin North Am 2018; 44:667-678. [PMID: 29078948 DOI: 10.1016/j.ogc.2017.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
There has been an emphasis on redesigning our health care system to eliminate medical errors and create a culture of safety. The American College of Obstetrics and Gynecologists defines a culture of safety as an environment in which all care providers are empowered to identify errors, near misses, risky behaviors and broader systems issues while engaging in active collaboration to improve and resolve processes and system failures. This article reviews key components that promote a culture of safety and help to implement safer, more effective, evidence-based quality care on labor and delivery units.
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Affiliation(s)
- Bethany Sabol
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA.
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA
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Paul ME, Dodge LE, Intondi E, Ozcelik G, Plitt K, Hacker MR. Integrating TeamSTEPPS ® into ambulatory reproductive health care: Early successes and lessons learned. J Healthc Risk Manag 2018; 36:25-36. [PMID: 28415149 DOI: 10.1002/jhrm.21271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Most medical teamwork improvement interventions have occurred in hospitals, and more efforts are needed to integrate them into ambulatory care settings. In 2014, Affiliates Risk Management Services, Inc. (ARMS), the risk management services organization for a large network of reproductive health care organizations in the United States, launched a voluntary 5-year initiative to implement a medical teamwork system in this network using the TeamSTEPPS model. This article describes the ARMS initiative and progress made during the first 2 years, including lessons learned. METHODS The ARMS TeamSTEPPS program consists of the following components: preparation of participating organizations, TeamSTEPPS master training, implementation of teamwork improvement programs, and evaluation. We used self-administered questionnaires to assess satisfaction with the ARMS program and with the master training course. RESULTS In the first 2 years, 20 organizations enrolled. Participants found the preparation phase valuable and were highly satisfied with the master training course. Although most attendees felt that the course imparted the knowledge and tools critical for TeamSTEPPS implementation, they identified time restraints and competing initiatives as potential barriers. The project team has learned valuable lessons about obtaining buy-in, consolidating the change teams, making the curriculum relevant, and evaluation. CONCLUSION Ambulatory care settings require innovative approaches to integration of teamwork improvement systems. Evaluating and sharing lessons learned will help to hone best practices as we navigate this new frontier in the field of patient safety.
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Affiliation(s)
| | | | | | | | - Ken Plitt
- Affiliates Risk Management Services, Inc
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Urbutė A, Paulionytė M, Jonauskaitė D, Machtejevienė E, Nadišauskienė RJ, Dambrauskas Ž, Dobožinskas P, Kliučinskas M. Perceived changes in knowledge and confidence of doctors and midwives after the completion of the Standardized Trainings in Obstetrical Emergencies. MEDICINA-LITHUANIA 2018; 53:403-409. [PMID: 29482880 DOI: 10.1016/j.medici.2018.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 12/22/2017] [Accepted: 01/23/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVES There are only few training programs in obstetric emergencies currently in use and only some of them were evaluated with an adequate sample of participants. Therefore, we present the evaluation of the novel Standardized Trainings in Obstetrical Emergencies (STrObE), conducted in Lithuania. The aim of this study was to analyze whether participants' self-reported knowledge and confidence increased after the trainings, and whether the impact of the trainings was long-lasting. MATERIALS AND METHODS Data was collected across the majority of hospitals providing secondary and tertiary obstetrical care in Lithuania in 2015. A total of 650 obstetricians-gynecologists and midwives attended the trainings; 388 (response rate 59.7%) of them filled in the initial questionnaire before the trainings, 252 (64.9%) immediately after, 160 (41.2%) 6 weeks after, and 160 (41.2%) 6 months after the trainings, which was the final sample for the analyses. Participants used a Likert-type scale to evaluate their knowledge and confidence about management of urgent obstetrical situations: vacuum-assisted vaginal delivery, shoulder dystocia, postpartum hemorrhage, preeclampsia/eclampsia, early preterm labor, and dystocia. We assessed how participants' self-reported knowledge and confidence changed after the trainings (compared to before the trainings) and how long the effect was retained for. RESULTS The mean score of self-reported knowledge in obstetrical emergencies increased immediately after the trainings comparing to the scores before the trainings (P<0.001) and it did not differ further between the three time points after the trainings (i.e. immediately, 6 weeks, and 6 months; P>0.05). The same pattern was observed for self-reported confidence scores. The increase in self-reported knowledge and confidence after the trainings was stable. Moreover, the self-reported knowledge and confidence gains were greater for those participants with lower work experience, although benefit was seen across all experience levels. CONCLUSIONS STrObE improved participants' self-reported knowledge and confidence and lasting positive effects were observed for at least 6 months after the initial trainings. Moreover, the trainings were more beneficial for those with lower work experience, although they benefited all the participants.
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Affiliation(s)
- Aivara Urbutė
- Department of Obstetrics and Gynecology, Herlev University Hospital, Herlev, Denmark; Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Marija Paulionytė
- Department of Obstetrics and Gynecology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Eglė Machtejevienė
- Department of Obstetrics and Gynecology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rūta J Nadišauskienė
- Department of Obstetrics and Gynecology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Žilvinas Dambrauskas
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Paulius Dobožinskas
- Department of Emergency Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mindaugas Kliučinskas
- Department of Obstetrics and Gynecology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Schwartz ME, Welsh DE, Paull DE, Knowles RS, DeLeeuw LD, Hemphill RR, Essen KE, Sculli GL. The effects of crew resource management on teamwork and safety climate at Veterans Health Administration facilities. J Healthc Risk Manag 2017; 38:17-37. [PMID: 29120515 DOI: 10.1002/jhrm.21292] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Communication failure is a significant source of adverse events in health care and a leading root cause of sentinel events reported to the Joint Commission. The Veterans Health Administration National Center for Patient Safety established Clinical Team Training (CTT) as a comprehensive program to enhance patient safety and to improve communication and teamwork among health care professionals. CTT is based on techniques used in aviation's Crew Resource Management (CRM) training. The aviation industry has reached a significant safety record in large part related to the culture change generated by CRM and sustained by its recurrent implementation. This article focuses on the improvement of communication, teamwork, and patient safety by utilizing a standardized, CRM-based, interprofessional, immersive training in diverse clinical areas. The Teamwork and Safety Climate Questionnaire was used to evaluate safety climate before and after CTT. The scores for all of the 27 questions on the questionnaire showed an increase from baseline to 12 months, and 11 of those increases were statistically significant. A recurrent training is recommended to maintain the positive outcomes. CTT enhances patient safety and reduces risk of patient harm by improving teamwork and facilitating clear, concise, specific and timely communication among health care professionals.
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Affiliation(s)
- Miriam E Schwartz
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI.,Greater Los Angeles Veterans Affairs (VA) Healthcare System, Los Angeles, CA.,David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Deborah E Welsh
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI
| | - Douglas E Paull
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI.,University of Michigan, Ann Arbor, MI.,Georgetown University School of Medicine, Washington, D.C
| | - Regina S Knowles
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI
| | - Lori D DeLeeuw
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI
| | - Robin R Hemphill
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI
| | - Keith E Essen
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI
| | - Gary L Sculli
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI
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Schneider PD, Sabol BA, Lee King PA, Caughey AB, Borders AEB. The Hard Work of Improving Outcomes for Mothers and Babies: Obstetric and Perinatal Quality Improvement Initiatives Make a Difference at the Hospital, State, and National Levels. Clin Perinatol 2017; 44:511-528. [PMID: 28802336 DOI: 10.1016/j.clp.2017.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Quality improvement efforts are an increasingly expanding focus for perinatal care providers across the United States. From successful hospital-level initiatives, there has been a growing effort to use and implement quality improvement work in substantive and meaningful ways. This article summarizes the foundations of maternal-focused, birth-focused, and neonatal-focused quality improvement initiatives to highlight the underpinnings and potential future directions of current state-level perinatal quality care collaboratives.
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Affiliation(s)
- Patrick D Schneider
- Maternal-Fetal Medicine, NorthShore University HealthSystem, University of Chicago, 2650 Ridge Avenue, Walgreen Building Suite 1506, Evanston, IL 60201, USA
| | - Bethany A Sabol
- Department of Obstetrics and Gynecology, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239-3098, USA
| | - Patricia Ann Lee King
- Feinberg School of Medicine, Northwestern University, 633 North St. Clair Street, Chicago, IL 60611, USA
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239-3098, USA
| | - Ann E B Borders
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem Evanston Hospital, Pritzker School of Medicine, University of Chicago, Walgreen Building, Suite 1507, Evanston, IL 60201, USA.
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Riley W, Begun JW, Meredith L, Miller KK, Connolly K, Price R, Muri JH, McCullough M, Davis S. Integrated Approach to Reduce Perinatal Adverse Events: Standardized Processes, Interdisciplinary Teamwork Training, and Performance Feedback. Health Serv Res 2016; 51 Suppl 3:2431-2452. [PMID: 27807864 PMCID: PMC5134347 DOI: 10.1111/1475-6773.12592] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To improve safety practices and reduce adverse events in perinatal units of acute care hospitals. DATA SOURCES Primary data collected from perinatal units of 14 hospitals participating in the intervention between 2008 and 2012. Baseline secondary data collected from the same hospitals between 2006 and 2007. STUDY DESIGN A prospective study involving 342,754 deliveries was conducted using a quality improvement collaborative that supported three primary interventions. Primary measures include adoption of three standardized care processes and four measures of outcomes. DATA COLLECTION METHODS Chart audits were conducted to measure the implementation of standardized care processes. Outcome measures were collected and validated by the National Perinatal Information Center. PRINCIPAL FINDINGS The hospital perinatal units increased use of all three care processes, raising consolidated overall use from 38 to 81 percent between 2008 and 2012. The harms measured by the Adverse Outcome Index decreased 14 percent, and a run chart analysis revealed two special causes associated with the interventions. CONCLUSIONS This study demonstrates the ability of hospital perinatal staff to implement efforts to reduce perinatal harm using a quality improvement collaborative. Findings help inform the relationship between the use of standardized care processes, teamwork training, and improved perinatal outcomes, and suggest that a multiplicity of integrated strategies, rather than a single intervention, may be essential to achieve high reliability.
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Affiliation(s)
- William Riley
- School for the Science of Health Care Delivery, Arizona State University, Phoenix, AZ
| | | | - Les Meredith
- Premier Insurance Management Services, Inc., San Diego, CA
| | | | | | - Rebecca Price
- Premier Insurance Management Services, San Diego, CA
| | - Janet H Muri
- National Perinatal Information Center, Providence, RI
| | - Mac McCullough
- School for the Science of Health Care Delivery, Arizona State University, Phoenix, AZ
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Austin N, Goldhaber-Fiebert S, Daniels K, Arafeh J, Grenon V, Welle D, Lipman S. Building Comprehensive Strategies for Obstetric Safety. Anesth Analg 2016; 123:1181-1190. [DOI: 10.1213/ane.0000000000001601] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gross AH, Leib RK, Tonachel A, Tonachel R, Bowers DM, Burnard RA, Rhinehart CA, Valentim R, Bunnell CA. Teamwork and Electronic Health Record Implementation: A Case Study of Preserving Effective Communication and Mutual Trust in a Changing Environment. J Oncol Pract 2016; 12:1075-1083. [DOI: 10.1200/jop.2016.013649] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This article describes how trust among team members and in the technology supporting them was eroded during implementation of an electronic health record (EHR) in an adult outpatient oncology practice at a comprehensive cancer center. Delays in care of a 38-year-old woman with high-risk breast cancer occurred because of ineffective team communication and are illustrated in a case study. The case explores how the patient’s trust and mutual trust between team members were disrupted because of inaccurate assumptions about the functionality of the EHR’s communication tool, resultant miscommunications between team members and the patient, and the eventual recognition that care was not being effectively coordinated, as it had been previously. Despite a well-established, team-based culture and significant preparation for the EHR implementation, the challenges that occurred point to underlying human and system failures from which other organizations going through a similar process may learn. Through an analysis and evaluation of events that transpired before and during the EHR rollout, suggested interventions for preventing this experience are offered, which include: a thorough crosswalk between old and new communication mechanisms before implementation; understanding and mitigation of gaps in the communication tool’s functionality; more robust training for staff, clinicians, and patients; greater consideration given to the pace of change expected of individuals; and development of models of collaboration between EHR users and vendors in developing products that support high-quality, team-based care in the oncology setting. These interventions are transferable to any organizational or system change that threatens mutual trust and effective communication.
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Khan A, Rogers JE, Forster CS, Furtak SL, Schuster MA, Landrigan CP. Communication and Shared Understanding Between Parents and Resident-Physicians at Night. Hosp Pediatr 2016; 6:319-29. [PMID: 27188189 DOI: 10.1542/hpeds.2015-0224] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Communication breakdowns between members of the health care team compromise patient safety and experience. Communication breakdowns with parents, an important but often overlooked part of the health care team, are understudied. Parents may play a particularly important role in nighttime care given decreased staffing and inadequate transitions of care at night. We studied communication breakdowns evidenced by lack of shared understanding between parents and night-team residents about the reason for admission and care plan. METHODS We conducted a prospective cohort study of parents (n = 286) and night-team senior residents (n = 34) from May 1, 2013 to October 31, 2013. Parents and residents rated communication and described patients' reason for admission, overall plan, and overnight plan. Two physician investigators independently reviewed (κ = 0.63) resident-parent dyads, assigned subsequently dichotomized 4-point overall agreement scores, and rated plan complexity. Using clustered logistic regression, we evaluated relationships among demographics, plan complexity, and shared understanding. We also examined resident and parent perceptions of shared understanding. RESULTS We analyzed data from 257 parent-resident dyads. Among these, 45.1% were rated as lacking shared understanding (agreement score = 1 or 2). In multivariate analysis, higher plan complexity (P < .001) and length of stay (P = .002) were associated with lack of shared understanding; lower parental education was a borderline predictor (P = .05). When surveyed, parents and residents reported that they shared an understanding with one another about care plans in 86.0% and 73.1% of cases, respectively. CONCLUSIONS Parents and night-team residents frequently lack shared understanding. Family-centered care initiatives to improve parent-provider communication and shared understanding may help empower parents as partners in safe and high-quality nighttime care.
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Affiliation(s)
- Alisa Khan
- Division of General Pediatrics, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and
| | - Jayne E Rogers
- Department of Nursing, Boston Children's Hospital, Boston, Massachusetts
| | | | | | - Mark A Schuster
- Division of General Pediatrics, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and
| | - Christopher P Landrigan
- Division of General Pediatrics, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Mancuso MP, Dziadkowiec O, Kleiner C, Halverson-Carpenter K, Link T, Barry J. Crew Resource Management for Obstetric and Neonatal Teams to Improve Communication During Cesarean Births. J Obstet Gynecol Neonatal Nurs 2016; 45:502-14. [PMID: 27290920 DOI: 10.1016/j.jogn.2016.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the effectiveness of crew resource management training and interventions on the quality and quantity of communication during cesarean births in a tertiary academic hospital's labor and birthing services. DESIGN A prospective pre-post crew resource management training intervention. SETTING Tertiary academic hospital in the Western United States. PARTICIPANTS All members of obstetric and neonatal teams that participated in cesarean births. METHODS Over a 5-month time period, all obstetric and neonatal staff were required to participate in team training in crew resource management critical language, communication, and team structure. Trained observers collected baseline data (n = 52) for 3 months on the quantity and quality of communications that occurred during cesarean births. Postintervention data (n = 50) were gathered for 3 months after team training. Analysis approach included use of Fisher's exact test, independent-samples t test, and multilevel generalized linear regression models with Poisson distribution. RESULTS There was a statistically significant increase in quantity and quality of communication from pre- to postintervention assessment for obstetric and neonatal staff. Although the increase in quality was similarly great between both types of teams, increase in quantity was more substantial in obstetric staff. CONCLUSION Principles of team communication training shown to be effective in increasing communication among team members in a variety of clinical areas were also effective in improving communication in the labor and birth setting during cesarean births.
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Edwards SE, Platt S, Lenguerrand E, Winter C, Mears J, Davis S, Lucas G, Hotton E, Fox R, Draycott T, Siassakos D. Effective interprofessional simulation training for medical and midwifery students. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2015; 1:87-93. [PMID: 35515198 DOI: 10.1136/bmjstel-2015-000022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/14/2015] [Indexed: 11/04/2022]
Abstract
Introduction Good interprofessional teamworking is essential for high quality, efficient and safe clinical care. Undergraduate interprofessional training has been advocated for many years to improve interprofessional working. However, few successful initiatives have been reported and even fewer have formally assessed their educational impact. Methods This was a prospective observational study of medical and midwifery students at a tertiary-level maternity unit. An interprofessional training module was developed and delivered by a multiprofessional faculty to medical and midwifery students, including short lectures, team-building exercises and practical simulation-based training for one obstetric (shoulder dystocia) and three generic emergencies (sepsis, haemorrhage, collapse). Outcome measures were interprofessional attitudes, assessed with a validated questionnaire (UWE Interprofessional Questionnaire) and clinical knowledge, measured with validated multiple-choice questions. Results Seventy-two students participated (34 medical, 38 midwifery). Following training median interprofessional attitude scores improved in all domains (p<0.0001), and more students responded in positive categories for communication and teamwork (69-89%, p=0.004), interprofessional interaction (3-16%, p=0.012) and interprofessional relationships (74-89%, p=0.006). Scores for knowledge improved following training for medical students (65.5% (61.8-70%) to 82.3% (79.1-84.5%) (median (IQR)) p<0.0001) and student midwives (70% (64.1-76.4%) to 81.8% (79.1-86.4%) p<0.0001), and in all subject areas (p<0.0001). Conclusions This training was associated with meaningful improvements in students' attitudes to teamwork, and knowledge acquisition. Integrating practical tasks and teamwork training, in authentic clinical settings, with matched numbers of medical and non-medical students can facilitate learning of both why and how to work together. This type of training could be adopted widely in undergraduate healthcare education.
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Affiliation(s)
- S E Edwards
- University of Bristol, School of Clinical Sciences, Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK
| | - S Platt
- Department of Obstetrics and Gynaecology, St Michael's Hospital, Bristol, UK
| | - E Lenguerrand
- University of Bristol School of Clinical Sciences, RISQ Research, Southmead Hospital, Bristol, UK
| | - C Winter
- Department of Obstetrics and Gynaecology, RISQ Research, Southmead Hospital, Bristol, UK
| | - J Mears
- Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK
| | - S Davis
- University of West of England, Health and Life Sciences, Bristol, UK
| | - G Lucas
- University of West of England, Health and Life Sciences, Bristol, UK
| | - E Hotton
- Department of Obstetrics and Gynaecology, Royal United Hospitals, Bath, UK
| | - R Fox
- Department of Obstetrics and Gynaecology, RISQ Research, Southmead Hospital, Bristol, UK
| | - T Draycott
- University of Bristol, School of Clinical Sciences, Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK
| | - D Siassakos
- University of Bristol, School of Clinical Sciences, Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK
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Bergh AM, Baloyi S, Pattinson RC. What is the impact of multi-professional emergency obstetric and neonatal care training? Best Pract Res Clin Obstet Gynaecol 2015; 29:1028-43. [PMID: 25937554 DOI: 10.1016/j.bpobgyn.2015.03.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 03/16/2015] [Indexed: 11/30/2022]
Abstract
This paper reviews evidence regarding change in health-care provider behaviour and maternal and neonatal outcomes as a result of emergency obstetric and neonatal care (EmONC) training. A refined version of the Kirkpatrick classification for programme evaluation was used to focus on change in efficiency and impact of training (levels 3 and 4). Twenty-three studies were reviewed - five randomised controlled trials, two quasi-experimental studies and 16 before-and-after observational studies. Training programmes had all been developed in high-income countries and adapted for use in low- and middle-income countries. Nine studies reported on behaviour change and 13 on process and patient outcomes. Most showed positive results. Every maternity unit should provide EmONC teamwork training, mandatory for all health-care providers. The challenges are as follows: scaling up such training to all institutions, sustaining regular in-service training, integrating training into institutional and health-system patient safety initiatives and 'thinking out of the box' in evaluation research.
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Affiliation(s)
- Anne-Marie Bergh
- MRC Maternal and Infant Health Care Strategies Unit, Obstetrics and Gynaecology Department, University of Pretoria, Pretoria, South Africa.
| | - Shisana Baloyi
- MRC Maternal and Infant Health Care Strategies Unit, Obstetrics and Gynaecology Department, University of Pretoria, Pretoria, South Africa.
| | - Robert C Pattinson
- MRC Maternal and Infant Health Care Strategies Unit, Obstetrics and Gynaecology Department, University of Pretoria, Pretoria, South Africa.
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Lyndon A, Sexton JB, Simpson KR, Rosenstein A, Lee KA, Wachter RM. Predictors of likelihood of speaking up about safety concerns in labour and delivery. BMJ Qual Saf 2014; 21:791-9. [PMID: 22927492 DOI: 10.1136/bmjqs-2010-050211] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Despite widespread emphasis on promoting 'assertive communication' by care givers as essential to patient-safety-improvement efforts, little is known about when and how clinicians speak up to address safety concerns. In this cross-sectional study, the authors use a new measure of speaking up to begin exploring this issue in maternity care. METHODS The authors developed a scenario-based measure of clinician's assessment of potential harm and likelihood of speaking up in response to perceived harm. The authors embedded this scale in a survey with measures of safety climate, teamwork climate, disruptive behaviour, work stress, and personality traits of bravery and assertiveness. The survey was distributed to all registered nurses and obstetricians practising in two US Labour & Delivery units. RESULTS The response rate was 54% (125 of 230 potential respondents). Respondents were experienced clinicians (13.7±11 years in specialty). A higher perception of harm, respondent role, specialty experience and site predicted the likelihood of speaking up when controlling for bravery and assertiveness. Physicians rated potential harm in common clinical scenarios lower than nurses did (7.5 vs 8.4 on 2-10 scale; p<0.001). Some participants (12%) indicated they were unlikely to speak up, despite perceiving a high potential for harm in certain situations. DISCUSSION This exploratory study found that nurses and physicians differed in their harm ratings, and harm rating was a predictor of speaking up. This may partially explain persistent discrepancies between physicians and nurses in teamwork climate scores. Differing assessments of potential harms inherent in everyday practice may be a target for teamwork intervention in maternity care.
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Affiliation(s)
- Audrey Lyndon
- Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA 94143, USA.
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Seelandt JC, Tschan F, Keller S, Beldi G, Jenni N, Kurmann A, Candinas D, Semmer NK. Assessing distractors and teamwork during surgery: developing an event-based method for direct observation. BMJ Qual Saf 2014; 23:918-29. [DOI: 10.1136/bmjqs-2014-002860] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hughes KM, Benenson RS, Krichten AE, Clancy KD, Ryan JP, Hammond C. A crew resource management program tailored to trauma resuscitation improves team behavior and communication. J Am Coll Surg 2014; 219:545-51. [PMID: 25026871 DOI: 10.1016/j.jamcollsurg.2014.03.049] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 03/03/2014] [Accepted: 03/12/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Crew Resource Management (CRM) is a team-building communication process first implemented in the aviation industry to improve safety. It has been used in health care, particularly in surgical and intensive care settings, to improve team dynamics and reduce errors. We adapted a CRM process for implementation in the trauma resuscitation area. STUDY DESIGN An interdisciplinary steering committee developed our CRM process to include a didactic classroom program based on a preimplementation survey of our trauma team members. Implementation with new cultural and process expectations followed. The Human Factors Attitude Survey and Communication and Teamwork Skills assessment tool were used to design, evaluate, and validate our CRM program. RESULTS The initial trauma communication survey was completed by 160 team members (49% response). Twenty-five trauma resuscitations were observed and scored using Communication and Teamwork Skills. Areas of concern were identified and 324 staff completed our 3-hour CRM course during a 3-month period. After CRM training, 132 communication surveys and 38 Communication and Teamwork Skills observations were completed. In the post-CRM survey, respondents indicated improvement in accuracy of field to medical command information (p = 0.029); accuracy of emergency department medical command information to the resuscitation area (p = 0.002); and team leader identity, communication of plan, and role assignment (p = 0.001). After CRM training, staff were more likely to speak up when patient safety was a concern (p = 0.002). CONCLUSIONS Crew Resource Management in the trauma resuscitation area enhances team dynamics, communication, and, ostensibly, patient safety. Philosophy and culture of CRM should be compulsory components of trauma programs and in resuscitation of injured patients.
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Verbeek-van Noord I, de Bruijne MC, Zwijnenberg NC, Jansma EP, van Dyck C, Wagner C. Does classroom-based Crew Resource Management training improve patient safety culture? A systematic review. SAGE Open Med 2014; 2:2050312114529561. [PMID: 26770720 PMCID: PMC4607184 DOI: 10.1177/2050312114529561] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/05/2014] [Indexed: 12/13/2022] Open
Abstract
AIM To evaluate the evidence of the effectiveness of classroom-based Crew Resource Management training on safety culture by a systematic review of literature. METHODS Studies were identified in PubMed, Cochrane Library, PsycINFO, and Educational Resources Information Center up to 19 December 2012. The Methods Guide for Comparative Effectiveness Reviews was used to assess the risk of bias in the individual studies. RESULTS In total, 22 manuscripts were included for review. Training settings, study designs, and evaluation methods varied widely. Most studies reporting only a selection of culture dimensions found mainly positive results, whereas studies reporting all safety culture dimensions of the particular survey found mixed results. On average, studies were at moderate risk of bias. CONCLUSION Evidence of the effectiveness of Crew Resource Management training in health care on safety culture is scarce and the validity of most studies is limited. The results underline the necessity of more valid study designs, preferably using triangulation methods.
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Affiliation(s)
- Inge Verbeek-van Noord
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Martine C de Bruijne
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Elise P Jansma
- Medical Library, VU University Amsterdam, Amsterdam, The Netherlands
| | - Cathy van Dyck
- Department of Organization Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Cordula Wagner
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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Milland M, Christoffersen JK, Hedegaard M. The size of the labor wards: is bigger better when it comes to patient safety? Acta Obstet Gynecol Scand 2013; 92:1271-6. [PMID: 24015949 DOI: 10.1111/aogs.12229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 07/29/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess possible associations between the size of labor units and the frequency of approved obstetric claims. DESIGN A nationwide retrospective descriptive study. SETTING Denmark. POPULATION All patients seeking financial compensation due to obstetric injuries occurring between 1995 and 2009. METHODS In all, 1440 anonymized obstetrics claims were reviewed; 1326 were included in the study. Information regarding the annual number of deliveries for each place of injury was retrieved from the National Birth Registry. MAIN OUTCOME MEASURES Obstetric injuries approved by the Danish Patient Insurance Association categorized by labor unit size. RESULTS The overall approval rate for submitted claims was 39.7%. Large labor units (3000-3999 deliveries/year) were found to have a lower approval rate (34.2%), compared with very large (≥4000 deliveries/year, 38.6%), intermediate (1000-2999 deliveries/year, 41.7%), and small (<1000 deliveries/year, 50.0%) units, (p < 0.05). The majority of compensation claims were approved with reference to the "specialist rule," assuming that if an experienced specialist had conducted the treatment differently the injury could have been avoided. Claims from small units showed a trend for being more often based on the specialist rule than seen in larger units (p < 0.05, test for trend). CONCLUSION The results may reflect that large labor units are living up to the principle of best practice to a greater degree. Several factors can be linked to the size of the labor unit and a better availability of in-house obstetricians as well as auxiliary specialists could be part of the explanation.
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Affiliation(s)
- Maria Milland
- Department of Obstetrics, Juliane Marie Center for Women, Children and Reproduction, Rigshospitalet, Copenhagen University Hospitals, Copenhagen, Denmark
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Raab CA, Will SEB, Richards SL, O'Mara E. The effect of collaboration on obstetric patient safety in three academic facilities. J Obstet Gynecol Neonatal Nurs 2013; 42:606-16. [PMID: 24004008 DOI: 10.1111/1552-6909.12234] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Interprofessional collaboration is critical to the provision of safe patient care and provider satisfaction. Collaboration is an active process that can help maximize positive patient outcomes. Three academic institutions implemented collaborative processes as part of their perinatal patient safety initiatives based on anecdotal experiences and safety culture surveys that demonstrated positive outcomes. Reliable tools and additional research are needed to measure the extent and impact of collaboration on patient outcomes in perinatal care.
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Block M, Ehrenworth JF, Cuce VM, Ng'ang'a N, Weinbach J, Saber S, Milic M, Urgo JA, Sokoli D, Schlesinger MD, Sexton JB. Measuring handoff quality in labor and delivery: development, validation, and application of the Coordination of Handoff Effectiveness Questionnaire (CHEQ). Jt Comm J Qual Patient Saf 2013; 39:213-20. [PMID: 23745480 DOI: 10.1016/s1553-7250(13)39028-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND A prospective, nonblinded intervention study was conducted (1) to evaluate the psychometric properties of a new questionnaire, the CHEQ (Coordination of Handoff Effectiveness Questionnaire) for measuring the quality of handoff interactions in labor and delivery (L&D) and (2) to demonstrate the utility of the CHEQ in evaluating the effectiveness of a previously described intervention, the tangible handoff, for standardizing handoffs in L&D. METHODS The CHEQ incorporates three existing handoff-related scales: teamwork climate, job satisfaction, and burnout. Two new scales--information quality and process quality--were developed, refined, and evaluated. The CHEQ was administered to 56 eligible L&D nurses pre- and post-implementation of the tangible handoff intervention. RESULTS Baseline and postintervention response rates for the CHEQ were 98% and 84%, respectively. Overall, the teamwork climate scale significantly improved from 57.17% to 68.35% (t = -2.84, p = .006), and the burnout scale significantly decreased from 49.70% to 36.21% (t = -2.56, p = .012) following implementation of the tangible handoff. Job satisfaction improved, although not at a statistically significant level. Cronbach's alpha results ranged from .68 to .96 for all scales, both pre- and post-intervention. CONCLUSIONS The CHEQ is psychometrically sound for evaluating handoffquality, is practical to administer, achieves high response rates, and is amenable to straightforward statistical analysis. The CHEQ is useful for evaluating handoff quality and gauging the responsiveness to a unit-level intervention in the scope of unit-level climate. The CHEQ may be replicated or adapted for other clinical areas to investigate handoffs and inform the design and evaluation of handoff interventions.
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Affiliation(s)
- Michael Block
- Department of Anesthesiology, Hackensack University Medical Center, Hackensack, New Jersey, USA.
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Cornthwaite K, Edwards S, Siassakos D. Reducing risk in maternity by optimising teamwork and leadership: an evidence-based approach to save mothers and babies. Best Pract Res Clin Obstet Gynaecol 2013; 27:571-81. [PMID: 23647702 DOI: 10.1016/j.bpobgyn.2013.04.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 04/10/2013] [Indexed: 12/20/2022]
Abstract
Poor teamwork results in preventable morbidity and mortality for mothers and babies. Suboptimal communication and lack of leadership cost not only lives but also money that is diverted from clinical care to insurance and litigation. Avoidable harm is usually not the result of staff failing their duty of care, it is the result of poor training failing hard-worked staff. A few simple teamwork and leadership behaviours can make a huge difference to outcome and experience for women and their companions, yet they are often missing from maternity care. Recent research has identified the problems and solutions, including the best way to train maternity teams to make a palpable difference. We describe simple yet evidence-based methods to improve teams and leaders.
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Sakala C, Yang YT, Corry MP. Maternity care and liability: most promising policy strategies for improvement. Womens Health Issues 2013; 23:e25-37. [PMID: 23312711 DOI: 10.1016/j.whi.2012.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 11/02/2012] [Accepted: 11/07/2012] [Indexed: 01/05/2023]
Abstract
BACKGROUND The present liability system is not serving well childbearing women and newborns, maternity care clinicians, or maternity care payers. Examination of evidence about the impact of this system on maternity care led us to identify seven aims for a high-functioning liability system in this clinical context. Herein, we identify policy strategies that are most likely to meet these aims and contribute to needed improvements. A companion paper considers strategies that hold little promise. METHODS We considered whether 25 strategies that have been used or proposed for improvement have met or could meet the seven aims. We used a best available evidence approach and drew on more recent empirical legal studies and health services research about maternity care and liability when available, and considered other studies when unavailable. FINDINGS Ten strategies seem to have potential to improve liability matters in maternity care across multiple aims. The most promising strategy--implementing rigorous maternity care quality improvement (QI) programs--has led to better quality and outcomes of care, and impressive declines in liability claims, payouts, and premium levels. CONCLUSIONS A number of promising strategies warrant demonstration and evaluation at the level of states, health systems, or other appropriate entities. Rigorous QI programs have a growing track record of contributing to diverse aims of a high-functioning liability system and seem to be a win-win-win prevention strategy for childbearing families, maternity care providers, and payers. Effective strategies are also needed to assist families when women and newborns are injured.
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Affiliation(s)
- Carol Sakala
- Childbirth Connection, New York, New York 10016, USA.
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Chang Pecci C, Mottl-Santiago J, Culpepper L, Heffner L, McMahan T, Lee-Parritz A. The Birth of a Collaborative Model. Obstet Gynecol Clin North Am 2012; 39:323-34. [DOI: 10.1016/j.ogc.2012.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Singh A, Nandi L. Obstetric emergencies: role of obstetric drill for a better maternal outcome. J Obstet Gynaecol India 2012; 62:291-6. [PMID: 23730032 DOI: 10.1007/s13224-012-0218-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Accepted: 05/28/2012] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate factors contributing to obstetric emergencies, analyze the fetomaternal outcome and role of obstetric drill in facing these emergencies effectively. MATERIAL AND METHOD Out of 10,892 deliveries, a total of 520 women were included in this prospective study. Analysis of emergency obstetric conditions was done by evaluating incidence, various contributing factors, and fetomaternal outcome. Obstetric drill was conducted among residents repetitively. Pre drill and post drill assessment of confidence in clinical, knowledge, and team work skills were compared by χ(2) test. Impact of drill on severe obstetric morbidities was noted. OBSERVATIONS Incidence of obstetric emergencies was found to be 4.88 %. Maternal and perinatal mortality was seen in 4.23 and 37.11 %, respectively, of these emergency obstetric women. Impact of drill showed an increase in score in knowledge (p < 0.019), confidence (p, 0.001), and team work (p < 0.001). CONCLUSION Active implementation of emergency obstetric care and incorporation of obstetric drill lays a strong foundation for safe fetomaternal outcome.
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Affiliation(s)
- Abha Singh
- Department of Obstetrics and Gynaecology, Pt. J.N.M. Medical College & Dr. B.R.A.M Hospital, Raipur, India
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Pratt S, Kenney L, Scott SD, Wu AW. How to Develop a Second Victim Support Program: A Toolkit for Health Care Organizations. Jt Comm J Qual Patient Saf 2012; 38:235-40, 193. [DOI: 10.1016/s1553-7250(12)38030-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Team spirit. Am J Surg 2012; 203:277-81. [PMID: 22281503 DOI: 10.1016/j.amjsurg.2011.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ayres-de-Campos D, Deering S, Siassakos D. Sustaining simulation training programmes--experience from maternity care. BJOG 2011; 118 Suppl 3:22-6. [PMID: 22039889 DOI: 10.1111/j.1471-0528.2011.03177.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There is little scientific evidence to support the majority of simulation-based maternity training programmes, but some characteristics appear to be associated with sustainability. Among these are a clear institutional-level commitment to the course, strong leadership in course organisation, a curriculum relevant to clinical practice, a nonthreatening learning environment, the establishment of multiprofessional training and the use of simulators appropriate to the learning objectives. There is still some debate on whether simulation-based sessions should be carried out in dedicated training time outside normal working hours or in ad-hoc drills that are run during clinical sessions, whether they should be located in clinical areas, simulation centres, or both, and whether or not they should include standardised generic teamwork training sessions. In this review, we discuss the main characteristics that appear to make a simulation-based training programme a sustainable initiative.
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Affiliation(s)
- D Ayres-de-Campos
- Department of Obstetrics and Gynaecology, Medical School, S. Joao Hospital, Institute of Biomedical Engineering, University of Porto, Porto, Portugal.
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Iverson RE, Heffner LJ. Patient safety series: obstetric safety improvement and its reflection in reserved claims. Am J Obstet Gynecol 2011; 205:398-401. [PMID: 21531371 DOI: 10.1016/j.ajog.2011.03.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 03/14/2011] [Indexed: 10/18/2022]
Abstract
In reviewing outcomes that are associated with the implementation of a series of labor and delivery patient safety efforts from 2004-2009, we requested data on the number of related professional liability claims that were reserved by our insurance companies that are established with the specific objective of financing risks that emanate from their parent group or groups. While we restructured the manner in which we give care, required training modules, and provided simulations to our providers, our legal risk continued to be monitored independently and in parallel. Retrospective review of the number of cases for which money was held in reserve for claims demonstrated a 20% decrease per year, which was adjusted for delivery volume, over this time period. We believe that the improved care that resulted from our safety projects has led to this decreased legal risk.
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Andreatta P, Frankel J, Boblick Smith S, Bullough A, Marzano D. Interdisciplinary team training identifies discrepancies in institutional policies and practices. Am J Obstet Gynecol 2011; 205:298-301. [PMID: 21457920 DOI: 10.1016/j.ajog.2011.02.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 01/15/2011] [Accepted: 02/04/2011] [Indexed: 10/18/2022]
Abstract
The objective of this study was to evaluate the impact of an interdisciplinary team-training program in obstetric emergencies on identifying unsupportive institutional policies and systems-based practices. We implemented a qualitative study design with a purposive sample of interdisciplinary physicians, nurses, and ancillary allied health professionals from 4 specialties (n = 79) to conduct a 6-month, weekly simulation-based intervention for managing obstetric emergencies. Debriefing focused on identifying discrepancies between clinical practice and institutional policies. Our data yielded 5 categories of discrepancies between institutional or departmental policy and actual clinical practice. Specific institutional policies and system-based practices were recommended to health system administration for reevaluation. Simulation-based interdisciplinary team training can inform system-wide quality improvement objectives that could lead to increased patient safety.
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Riley W, Davis S, Miller K, Hansen H, Sainfort F, Sweet R. Didactic and Simulation Nontechnical Skills Team Training to Improve Perinatal Patient Outcomes in a Community Hospital. Jt Comm J Qual Patient Saf 2011; 37:357-64. [DOI: 10.1016/s1553-7250(11)37046-8] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rosenstein AH. Managing disruptive behaviors in the health care setting: focus on obstetrics services. Am J Obstet Gynecol 2011; 204:187-92. [PMID: 21183152 DOI: 10.1016/j.ajog.2010.10.899] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 07/09/2010] [Accepted: 10/12/2010] [Indexed: 12/26/2022]
Abstract
Disruptive behaviors can have a significant negative impact on staff relationships, communication flow, task responsibility, and team collaboration, all of which can adversely impact patient outcomes of care. Addressing disruptive behaviors in a positive manner by emphasizing the benefits of mutual understanding, shared goals and priorities, and adherence to accepted standards of care will enhance communication flow and improve the process and outcomes of care. This is particularly relevant in the obstetrics setting, where care is delivered over a continuum of time, with multiple different members of the health care team playing a vital role as the patient progresses from labor to delivery. Critical strategies for success include having strong organizational commitment and leadership support, raising provider insight and awareness, implementing appropriate policies and procedures, providing appropriate educational and training programs, and facilitating action-oriented interventional support.
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Affiliation(s)
- Alan H Rosenstein
- Physician Wellness Services-San Francisco, 139 15th Ave., San Francisco, CA 94118, USA.
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Abstract
Multidisciplinary education (MDE) is perceived as the next means of implementing major improvements in the quality and cost-effectiveness of patient care. In this article, the authors discuss various definitions of MDE, evaluate how MDE might be implemented in clinical arenas relevant to the anesthesiologist, and describe several implementations of MDE within their hospital and the anesthesiology department.
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Walker S, Strandjord TP, Benedetti TJ. In search of perinatal quality outcome measures: 1 hospital's in-depth analysis of the Adverse Outcomes Index. Am J Obstet Gynecol 2010; 203:336.e1-7. [PMID: 20599182 DOI: 10.1016/j.ajog.2010.05.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 04/09/2010] [Accepted: 05/11/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the Adverse Outcome Index perinatal quality indicator system that was derived from administrative data. STUDY DESIGN Adverse events were identified for 10 component measures; the Adverse Outcome Index was calculated by the National Perinatal Information Center from 42 months of administrative data. After retrospective chart review, we estimated positive predictive value for 10 measures that were obtained by corrected calculations of Adverse Outcome Index. RESULTS Positive predictive values were 86-100% in 7 indicators, with lower values in 3 indicators: neonatal death, 0/2 fetuses; inborn birth trauma, 22/33 infants (67%); and maternal return to the operating room, 16/33 women (48.5%). In term admission to the neonatal intensive care unit, 107 false negatives were identified, with a negative predictive value of 45%. CONCLUSION Indicator positive predictive value was variable. Performance can be strengthened by methods to identify both false-positive and false-negative adverse events that would include chart review and some measure specification revisions to improve alignment with original indicator intent. Interhospital comparison application requires further study.
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Siassakos D, Draycott TJ, Crofts JF, Hunt LP, Winter C, Fox R. More to teamwork than knowledge, skill and attitude. BJOG 2010; 117:1262-9. [PMID: 20618313 DOI: 10.1111/j.1471-0528.2010.02654.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess whether team performance in simulated eclampsia is related to the knowledge, skills and attitudes of individual team members. DESIGN Cross-sectional analysis of data from the Simulation and Fire Drill Evaluation randomised controlled trial. SETTING Six secondary and tertiary maternity units in south-west England. PARTICIPANTS One hundred and fourteen maternity professionals in 19 teams of six members; one senior and one junior obstetrician; two senior and two junior midwives. METHODS We validated a team performance ranking scheme with respect to magnesium administration (Magnesium Administration Rank, MAR) by expert consensus (face validity) and correlation with clinical measures (construct validity). We tested for correlation between MAR and measures of knowledge, skills and attitudes. MAIN OUTCOME MEASURES Correlation between team performance (MAR) and scores in validated multiple-choice questionnaires (MCQs) (knowledge), a measure of individual manual skill to manage an obstetric emergency (skill) and scores in a widely used teamwork/safety attitude questionnaire (attitude). RESULTS There was no relationship between team performance and cumulative individual MCQs, skill or teamwork/safety attitude scores. CONCLUSIONS The knowledge, manual skills and attitudes of the individuals comprising each team, measured by established methods, did not correlate in this study with the team's clinical efficiency in the management of simulated eclampsia. The inference is that unidentified characteristic(s) play a crucial part in the efficiency of teams managing emergencies. Any emphasis of training programmes to promote individual knowledge, skills and attitudes alone may have to be re-examined. This highlights a need to understand what makes a team efficient in dealing with clinical emergencies.
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Siassakos D, Hasafa Z, Sibanda T, Fox R, Donald F, Winter C, Draycott T. Retrospective cohort study of diagnosis-delivery interval with umbilical cord prolapse: the effect of team training. BJOG 2009; 116:1089-96. [PMID: 19438496 DOI: 10.1111/j.1471-0528.2009.02179.x] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether the introduction of multi-professional simulation training was associated with improvements in the management of cord prolapse, in particular, the diagnosis-delivery interval (DDI). DESIGN Retrospective cohort study. SETTING Large tertiary maternity unit within a University Hospital in the United Kingdom. SAMPLE All cases of cord prolapse with informative case record: 34 pre-training, 28 post-training. METHODS Review of hospital notes and software system entries; comparison of quality of management for umbilical cord prolapse pre-training (1993-99) and post-training (2001-07). MAIN OUTCOME MEASURES Diagnosis-delivery interval; proportion of caesarean section (CS) in whom actions were taken to reduce cord compression; type of anaesthesia for CS births; rate of low (<7) 5-minute Apgar scores; rate of admission to neonatal intensive care unit (NICU) (if birthweight >2500 g). RESULTS After training, there was a statistically significant reduction in median DDI from 25 to 14.5 minutes (P < 0.001). Post-training, there was also a statistically significant increase in the proportion of CS where recommended actions had been performed (from 34.78 to 82.35%, P = 0.003). There was a nonsignificant increase in the use of spinal anaesthesia for CS, from 8.70 to 17.65%, and a nonsignificant reduction in the rate of low Apgar scores from 6.45 to 0% and in the rate of admission to NICU from 38.46 to 22.22%. CONCLUSIONS The introduction of annual training, in accordance with national recommendations, was associated with improved management of cord prolapse. Future studies could assess whether this improved management translates into better outcomes for babies and their mothers.
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Affiliation(s)
- D Siassakos
- Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK.
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Siassakos D, Crofts JF, Winter C, Weiner CP, Draycott TJ. The active components of effective training in obstetric emergencies. BJOG 2009; 116:1028-32. [PMID: 19438497 DOI: 10.1111/j.1471-0528.2009.02178.x] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Confidential enquiries into poor perinatal outcomes have identified deficiencies in team working as a common factor and have recommended team training in the management of obstetric emergencies. Isolated aviation-based team training programmes have not been associated with improved perinatal outcomes when applied to labour ward settings, whereas obstetric-specific training interventions with integrated teamwork have been associated with clinical improvements. This commentary reviews obstetric emergency training programmes from hospitals that have demonstrated improved outcomes to determine the active components of effective training. The common features identified were: institution-level incentives to train; multi-professional training of all staff in their units; teamwork training integrated with clinical teaching and use of high fidelity simulation models. Local training also appeared to facilitate self-directed infrastructural change.
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Affiliation(s)
- D Siassakos
- Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK.
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Abstract
This manuscript represents an overview of a presentation at the SSAT 49th annual meeting which describes the evolution of the author's work within surgery to build and advance teamwork into processes of care.
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Abstract
Whether seeing a patient in the ambulatory clinic environment, performing a delivery or managing a critically ill patient, obstetric care is a team activity. Failures in teamwork and communication are among the leading causes of adverse obstetric events, accounting for over 70% of sentinel events according to the Joint Commission. Effective, efficient and safe care requires good teamwork. Although nurses, doctors and healthcare staff who work in critical care environments are extremely well trained and competent medically, they have not traditionally been trained in how to work well as part of a team. Given the complexity and acuity of critical care medicine, which often relies on more than one medical team, teamwork skills are essential. This chapter discusses the history and importance of teamwork in high-reliability fields, reviews key concepts and skills in teamwork, and discusses approaches to training and working in teams.
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Affiliation(s)
- Jeanne-Marie Guise
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239-3098, USA.
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