The impact of transmural multiprofessional simulation-based obstetric team training on perinatal outcome and quality of care in the Netherlands

BMC Medical Education

Guid S Oei³  Pieter J van Runnard Heimel¹  Jeanne P Dieleman²  Annemarie F Fransen¹  Sophie E M Truijens¹  Franyke R Banga¹ 

[1] Department of Obstetrics and Gynaecology, Máxima Medical Centre, De Run 4600, P.O. Box 7777, Veldhoven, 5500 MB, The Netherlands;MMC Academie, Máxima Medical Centre, Veldhoven, The Netherlands;Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands

关键词: Quality of care;    Crew resource management;    Deliberate practice;    Simulation-based obstetric team training;    Multiprofessional;   

Others  :  1091781
DOI  :  10.1186/1472-6920-14-175

 received in 2014-07-15, accepted in 2014-08-14,  发布年份 2014

【 摘 要 】

Background

Perinatal mortality and morbidity in the Netherlands is relatively high compared to other European countries. Our country has a unique system with an independent primary care providing care to low-risk pregnancies and a secondary/tertiary care responsible for high-risk pregnancies. About 65% of pregnant women in the Netherlands will be referred from primary to secondary care implicating multiple medical handovers. Dutch audits concluded that in the entire obstetric collaborative network process parameters could be improved. Studies have shown that obstetric team training improves perinatal outcome and that simulation-based obstetric team training implementing crew resource management (CRM) improves team performance. In addition, deliberate practice (DP) improves medical skills. The aim of this study is to analyse whether transmural multiprofessional simulation-based obstetric team training improves perinatal outcome.

Methods/Design

The study will be implemented in the south-eastern part of the Netherlands with an annual delivery rate of over 9,000. In this area secondary care is provided by four hospitals. Each hospital with referring primary care practices will form a cluster (study group). Within each cluster, teams will be formed of different care providers representing the obstetric collaborative network. CRM and elements of DP will be implemented in the training. To analyse the quality of care as perceived by patients, the Pregnancy and Childbirth Questionnaire (PCQ) will be used. Furthermore, self-reported collaboration between care providers will be assessed. Team performance will be measured by the Clinical Teamwork Scale (CTS). We employ a stepped-wedge trial design with a sequential roll-out of the trainings for the different study groups.

Primary outcome will be perinatal mortality and/or admission to a NICU. Secondary outcome will be team performance, quality of care as perceived by patients, and collaboration among care providers.

Conclusion

The effect of transmural multiprofessional simulation-based obstetric team training on perinatal outcome has never been studied. We hypothesise that this training will improve perinatal outcome, team performance, and quality of care as perceived by patients and care providers.

Trial registration

The Netherlands National Trial Register, http://www.trialregister.nl/NTR4576 webcite, registered June 1, 2014

【 授权许可】

   
2014 Banga et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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Figure 3.

【 参考文献 】

• [1]Buitendijk SE, Nijhuis JG: High perinatal mortality in the Netherlands compared to the rest of Europe. Ned Tijdschr Geneeskd 2004, 148:1855-1860.
• [2]Mohangoo AD, Buitendijk SE, Hukkelhoven CW, Ravelli AC, van Driel GC R, Tamminga P, et al.: Higher perinatal mortality in the Netherlands than in other European countries: the Peristat-II study. Ned Tijdschr Geneeskd 2008, 152:2718-2727.
• [3]Zeitlin J, Mohangoo A, Cuttini M, EURO-PERISTAT Report Writing Committee: The European Perinatal Health Report: comparing the health and care of pregnant women and newborn babies in Europe. J Epidemiol Community Health 2009, 63:681-682.
• [4]EURO-PERISTAT project in collaboration with SCPE, EUROCAT and EURONEOSTAT: European perinatal health report. 2008. http://www.europeristat.com webcite
• [5]Euro-Peristat Project with SCPE and EUROCAT: European Perinatal Health Report. The health and care of pregnant women and babies in Europe in 2010http://www.europeristat.com webcite
• [6]Eurostat: The Eurostat Regional Yearbook . Publications Office of the European Union: Luxembourg; 2011.
• [7]The Netherlands Perinatal Registry: Trends 1999–2012. The Netherlands Perinatal Registry: Utrecht; 2013.
• [8]Commissie verloskunde van het CVZ: Verloskundig vademecum 2003. Diemen: College voor zorgverzekeringen; 2003.
• [9]Franx A: Lijn der verwachting. Utrecht University: Utrecht; 2011.
• [10]Stuurgroep zwangerschap en geboorte: Een goed begin. Utrecht: Stuurgroep zwangerschap en geboorte; 2009.
• [11]PRN 2007: Perinatale Zorg in Nederland 2007. Utrecht: PRN; 2009. http://www.perinatreg.nl/uploads/150/116/Jaarboek_Perinatale_Zorg_2007.pdf webcite
• [12]Amelink-Verburg MP, Verloove-Vanhorick SP, Hakkenberg RM, Veldhuijzen IM, Bennebroek GJ, Buitendijk SE: Evaluation of 280,000 cases in Dutch midwifery practices: a descriptive study. BJOG 2008, 115:570-578.
• [13]Van Eyck JPM, Offermans AC, Bolte KM, Sollie-Szarynska KWM, Bloemenkamp SG, Oei MP, Heringa FK, Lotgering JJ, Duvekot A, Schaap AHP: OHC rapportage 2008. Ned Tijdschr Geneeskd 2008, 152:2121-2125.
• [14]de Neef T, Hukkelhoven CW, Franx A, Everhardt E: Uit de lijn der verwachting. Nederl Tijdschrift Obstet Gynaecol 2009, 122:341-342.
• [15]Evers AC, Brouwers HA, Hukkelhoven CW, Nikkels PG, Boon J, van Egmond-Linden A, Hillegersberg J, Snuif YS, Sterken-Hooisma S, Bruinse HW, Kwee A: Perinatal mortality and severe morbidity in low and high risk pregnancies in the Netherlands: a prospective cohort study. BMJ 2010, 341:c5639.
• [16]de Jonge A, van der Goes B, Ravelli A, Amelink-Verburg M, Mol B, Nijhuis J, Bennebroek Gravenhorst J, Buitendijk S: Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births. BJOG 2009, 116:1177-1184.
• [17]Birthplace in England Collaborative Group: Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ 2011, 343:d7400.
• [18]Bonsel GJ, Birnie E, Denktas S, Poeran J, Steegers EAP: Lijnen inde Perinatale Sterfte, Signalementstudie Zwangerschap en Geboorte 2010. Rotterdam: Erasmus MC; 2010.
• [19]Ravelli ACJ, Eskes M, Tromp M, van Huis AM, Steegers EAP, Tamminga P, Bonsel GJ: Perinatale sterfte in Nederland 2000–2006; risicofactoren en risicoselectie. Ned Tijdschr Geneeskd 2008, 152:2728-2733.
• [20]Tamminga P, Rijninks-van Driel G, Mohangoo A, Hukkelhoven C, Nijhuis J, Buitendijk S, Ravelli ACJ: Neonatale uitkomsten. Nederl Tijdschrift Obstet Gynaecol 2009, 122:83-87.
• [21]Richardus JH, Graafmans WC, Verloove-Vanhorick SP, Mackenbach JP, EuroNatal International Audit Panel; EuroNatal Working Group: Differences in perinatal mortality and suboptimal care between 10 European regions: results of an international audit. BJOG 2003, 110:97-105.
• [22]Stichting Perinatale Audit Nederland: A terme sterfte 2010. Perinatale audit: eerste verkenningen. Stichting Perinatale Audit Nederland: Utrecht; 2011.
• [23]Lledo R, Rodríguez T, Trilla A, Cararach V, Restuccia J, Asenjo M: Perceived quality of care in pregnancy. Assessment before and after delivery. Eur J Obstet Gynecol Reprod Biol 2000, 88:35-42.
• [24]Wildman K, Blondel B, Nijhuis J, Defoort P, Bakoula C: European indicators of health care during pregnancy, delivery and the postpartum period. Eur J Obstet Gynecol Reprod Biol 2003, 111:53-65.
• [25]Draycott T, Sibanda T, Laxton C, Winter C, Mahmood T, Fox R: Quality improvement demands quality measurement. BJOG 2010, 117:1571-1574.
• [26]Siassakos D, Bristowe K, Draycott TJ, Angouri J, Hambly H, Winter C, Crofts JF, Hunt LP, Fox R: Clinical efficiency in a simulated emergency and relationship to team behaviours: a multisite cross-sectional study. BJOG 2011, 118:596-607.
• [27]Posthumus AG, Schölmerich VL, Waelput AJ, Vos AA, De Jong-Potjer LC, Bakker R, Bonsel GJ, Groenewegen P, Steegers EA, Denktaş S: Bridging between professionals in perinatal care: towards shared care in the Netherlands. Matern Child Health J 2013, 17(10):1981-1989.
• [28]Truijens SEM, Pommer AM, Van Runnard Heimel PJ, Verhoeven CJM, Oei SG, Pop VJM: Development of the Pregnancy and Childbirth Questionnaire (PCQ): evaluating quality of care as perceived by women who recently gave birth. Eur J Obstet Gynecol Reprod Biol 2014, 174:35-40.
• [29]Draycott T, Sibanda T, Owen L, Akande V, Winter C, Reading S, Whitelaw A: Does training in obstetric emergencies improve neonatal outcome? BJOG 2006, 113:177-182.
• [30]Cook DA, Hatala R, Brydges R, Zendejas B, Szostek JH, Wang AT, Erwin PJ, Hamstra SJ: Technology-enhanced simulation for health professions education; a systematic review and meta-analysis. JAMA 2011, 306:978-988.
• [31]McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB: Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Acad Med 2011, 86:706-711.
• [32]Ericsson KA: Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Review. Acad Med 2004, 79(10 Suppl):S70-S81.
• [33]Helmreich RL, Merrit AC, Wilhelm JA: The evolution of crew resource management in training in commercial aviation. Int J Aviat Psychol 1999, 9:19-32.
• [34]Grogan EL, Stiles RA, France DJ, Speroff T, Morris JA, Nixon B, Gaffney FA, Seddon R, Pinson CW: The impact of aviation-based teamwork training on the attitudes of health-care professionals. J Am Coll Surg 2004, 199:843-848.
• [35]Kirkpatrick D: Evaluating training programmes; the four levels. San Francisco, CA: Berrett-Kochler Publishers; 1994.
• [36]Fransen AF, van de Ven J, Merién AER, de Wit-Zuurendonk L, Houterman S, Mol BW, Oei SG: Effect of obstetric team training on team performance and medical technical skills: a randomised controlled trial. Br J Obstet Gynaecol 2012, 119:1387-1393.
• [37]Brown CA, Lilford RJ: The stepped wedge trial design, a systematic review. BMC Med Res Methodol 2006, 8:6-54.
• [38]Woertman W, de Hoop E, Moerbeek M, Zuidema SU, Gerritsen DL, Teerenstra S: Stepped wedge designs could reduce the required sample size in cluster randomized trials. J Clin Epidemiol 2013, 66(7):752-758.
• [39]Mdege ND, Man MS, Taylor Nee Brown CA, Torgerson DJ: Systematic review of stepped wedge cluster randomized trials shows that design is particularly used to evaluate interventions during routine implementation. J Clin Epidemiol 2011, 64(9):936-948.
• [40]Medical Education and Simulation Centre (Medsim) the Netherlands: Eindhoven; http://www.medsim.nl webcite
• [41]Dutch Society of Obstetrics and Gynaecology: Multidisciplinary guideline of preterm birth. NVOG: Utrecht; 2012. http://www.nvog.nl webcite
• [42]Dutch Society of Obstetrics and Gynaecology: Guideline prevention of recurrence of preterm birth. NVOG: Utrecht; 2007. http://www.nvog.nl webcite
• [43]Dutch Society of Obstetrics and Gynaecology: Guideline calculation of gestational age. NVOG: Utrecht; 2011. http://www.nvog.nl webcite
• [44]Dutch Society of Obstetrics and Gynaecology: Multidisciplinary guideline of extreme preterm birth. NVOG: Utrecht; 2010. http://www.nvog.nl webcite
• [45]Royal College of Obstetricians and Gynaecologists (RCOG): The Investigation and Management of the Small–for–Gestational–Age Fetus. In RCOG green Guidline NO 31. London: RCOG; 2013.
• [46]Dutch Society of Obstetrics and Gynaecology: Small-for-Gestational-Age Fetus. NVOG: Utrecht; 2008.
• [47]Royal College of Obstetricians and Gynaecologists (RCOG): Electrical fetal monitoring. In National Evidence-based Clinical Guideline. London: RCOG Press; 2001.
• [48]Health, National Collaborating Centre for Women’s and Children’s: Intrapartum Care: care of healthy women and their babies during childbirth. In NICE Clinical guideline 55. Londen: RCOG Press; 2007.
• [49]Nederlandse Reanimatie Raad/Belgische reanimatieraad: Resuscitation of newborns; guidelines resuscitation in the Netherlands. Nederlandse Reanimatie Raad: Uden; 2010. http://www.reanimatieraad.nl webcite
• [50]Nolan JP, Soar J, Zideman DA, Biarent D, Bossaert LL, Deakin C, Koster RW, Wyllie J, Böttiger B: ERC Guidelines Writing Group. European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation 2010, 81(10):1219-1276.
• [51]Dutch Society of Obstetrics and Gynaecology: Guideline unexpected findings with 18–20 week scan. NVOG: Utrecht; 2008.
• [52]Dutch Society of Obstetrics and Gynaecology: Guideline late termination of pregnancy. NVOG: Utrecht; 2007.
• [53]Guise JM, Deering SH, Kanki BG, Osterweil P, Li H, Mori M, Lowe NK: Validation of a tool to measure and promote clinical teamwork. Simul Healthc 2008, 3:217-223.
• [54]Berendsen AJ, Benneker WH, Groenier KH, Schuling J, Grol RP, Meyboom-de JB: DOC questionnaire: measuring how GPs and medical specialists rate collaboration. Int J Health Care Qual Assur 2010, 23:516-526.