Team training in obstetric and neonatal emergencies using highly realistic simulation in Mexico: impact on process indicators

BMC Pregnancy and Childbirth

Jenifer O Fahey³  Julia C Dettinger⁶  Dolores Gonzalez Hernandez⁵  Jessica Greenberg Cowan⁴  Hector Lamadrid-Figueroa⁵  Marisela Olvera⁵  Jimena Fritz⁵  Susanna Cohen¹  Dilys Walker² 

[1] College of Nursing, University of Utah, 10 South 2000, East Salt Lake City 84112, UT, USA;Department of Obstetrics and Gynecology, University of Washington, 325 9th Ave, Seattle 98104, WA, USA;Department of Obstetrics and Gynecology, University of Maryland School of Medicine, 22 S Green St, Baltimore 12201, MD, USA;Clinical Faculty, Department of Family Medicine, Swedish Hospital, 747 Broadway, Seattle 98122, WA, USA;Division of Reproductive Health, Research Center for Population Health, National Institute of Public Health, Universidad No 655 Col Santa Maria Ahuacatitlan, Cerrada los Pinos y Caminera, Cuernavaca, 621000, CP, Mexico;Department of Global Health, University of Washington, 325 9th Ave, Seattle 98104, WA, USA

关键词: Limited-resource;    Team training;    Simulation;    Neonatal resuscitation;    Obstetric emergencies;    Interprofessional;   

Others  :  1091632
DOI  :  10.1186/s12884-014-0367-1

 received in 2014-01-30, accepted in 2014-10-15,  发布年份 2014

【 摘 要 】

Background

Ineffective management of obstetric emergencies contributes significantly to maternal and neonatal morbidity and mortality in Mexico. PRONTO (Programa de Rescate Obstétrico y Neonatal: Tratamiento Óptimo y Oportuno) is a highly-realistic, low-tech simulation-based obstetric and neonatal emergency training program. A pair-matched hospital-based controlled implementation trial was undertaken in three states in Mexico, with pre/post measurement of process indicators at intervention hospitals. This report assesses the impact of PRONTO simulation training on process indicators from the pre/post study design for process indicators.

Methods

Data was collected in twelve intervention facilities on process indicators, including pre/post changes in knowledge and self-efficacy of obstetric emergencies and neonatal resuscitation, achievement of strategic planning goals established during training and changes in teamwork scores. Authors performed a longitudinal fixed-effects linear regression model to estimate changes in knowledge and self-efficacy and logistic regression to assess goal achievement.

Results

A total of 450 professionals in interprofessional teams were trained. Significant increases in knowledge and self-efficacy were noted for both physicians and nurses (p <0.001- 0.009) in all domains. Teamwork scores improved and were maintained over a three month period. A mean of 58.8% strategic planning goals per team in each hospital were achieved. There was no association between high goal achievement and knowledge, self-efficacy, proportion of doctors or nurses in training, state, or teamwork score.

Conclusions

These results suggest that PRONTO’s highly realistic, locally appropriate simulation and team training in maternal and neonatal emergency care may be a promising avenue for optimizing emergency response and improving quality of facility-based obstetric and neonatal care in resource-limited settings.

Trial registration

NCT01477554 webcite

【 授权许可】

   
2014 Walker et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Lozano R, Wang H, Foreman KJ, Rajaratnam JK, Naghavi M, Marcus JR, Dwyer-Lindgren L, Lofgren KT, Phillips D, Atkinson C, Lopez AD, Murray CJL: Progress towards millennium development goals 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet 2011, 378:1139-1165.
• [2]Hill K, Thomas K, AbouZahr C, Walker N, Say L, Inoue M, Suzuki E: Estimates of maternal mortality worldwide between 1990 and 2005: an assessment of available data. Lancet 2007, 370:1311-1319.
• [3]Khayat R, Cambell O: Hospital practices in maternity wards in Lebanon. Health Policy Plan 2000, 15:270-278.
• [4]Miller S, Cordero M, Coleman AL, Figueroa J, Brito-anderson S, Dabagh R, Calderon V, Caceres F, Fernandez A, Nunez M: Quality of care in institutionalized deliveries: the paradox of the Dominican Republic. Int J Gynecol Obstet 2003, 82:89-103.
• [5]Hofmeyr GJ, Haws RA, Bergström S, Lee ACC, Okong P, Darmstadt GL, Mullany LC, Oo EKS, Lawn JE: Obstetric care in low-resource settings: what, who, and how to overcome challenges to scale up? Int J Gynaecol Obstet Off puplication Int Fed Gynaecol Obstet 2009, 107 Suppl:S21-S44. S44–5
• [6]Thaddeaus S, Maine D: Too far to walk: maternal mortality in context. Soc Sci Med 1994, 38:1091-1110.
• [7]Davis D, Thomson O’Brien MA, Freemantle N, Wolf FM, Mazmanian P, Taylor-vaisey A: Impact of formal continuing medical education: do conferences, workshops, rounds and other traditional continuing education activities change physcian behavior or health care outcomes? JAMA J Am Med Assoc 1999, 282:867-874.
• [8]Siassakos D, Crofts JF, Winter C, Weiner CP, Draycott TJ: The active components of effective training in obstetric emergencies. BJOG 2009, 116:1028-1032.
• [9]Pasha O, McClure EM, Wright LL, Saleem S, Goudar SS, Chomba E, Patel A, Esamai F, Garces A, Althabe F, Kodkany B, Mabeya H, Manasyan A, Carlo W a, Derman RJ, Hibberd PL, Liechty EK, Krebs N, Hambidge KM, Buekens P, Moore J, Jobe AH, Koso-Thomas M, Wallace DD, Stalls S, Goldenberg RL: A combined community- and facility-based approach to improve pregnancy outcomes in low-resource settings: a global network cluster randomized trial. BMC Med 2013, 11:215. BioMed Central Full Text
• [10]Black RS, Brocklehurst P: A systematic review of training in acute obstetric emergencies. BJOG 2003, 110:837-841.
• [11]Rodriguez-Ramirez S, Mundo-Rosas V, Jimenez-Aguilar A, Shamah-Levy T: Methodology for the analysis of the dietary data from the Mexican National Health and Nutrition Survey 2006. Salud Publica de Mexico 2009, 51:sup 4.
• [12]Crofts JF, Winter C, Sowter MC: Practical simulation training for maternity care–where we are and where next. BJOG 2011, 118(Suppl 3):11-16.
• [13]Kawaguchi A, Mori R: The In-service training for health professionals to improve care of the seriously ill newborn or child in low- and middle-income countries. (last revised: 1 November 2010). The WHO Reproductive Health Library. Geneva: World Health Organization.
• [14]Andreatta P, Gans-Larty F, Debpuur D, Ofosu A, Perosky J: Evaluation of simulation-based training on the ability of birth attendants to correctly perform bimanual compression as obstetric first aid. Int J Nurs Stud 2011, 48:1275-1280.
• [15]Best K a, Seibel BE, Lyon DS: Grommets and glue guns: standardization of a pfannenstiel model for low-fidelity obstetrics-gynecology education. J Grad Med Educ 2009, 1:264-268.
• [16]Cohen SR, Cragin L, Wong B, Walker DM: Self-efficacy change with low-tech, high-fidelity obstetric simulation training for midwives and nurses in Mexico. Clin Simul Nurs 2012, 8:e15-e24.
• [17]Deganus S: SYMPTEK homemade foam models for client education and emergency obstetric care skills training in low-resource settings. J Obstet Gynaecol Canada 2009, 31:930-935.
• [18]Secretaria de salud. Programa Nacional de Salud: Monitoring Targets, Performance Measurement and Accountability of the National Health Program 2007–2012. Secretaria de salud; 2007:131–144.
• [19]Echeveria DFD: Mortalidad Materna: Una Tarea Inconclusa. Centro de analisis e investigacion, A.C; 2006.
• [20]Walker DM, Cohen SR, Estrada F, Monterroso ME, Jenny A, Fritz J, Fahey JO: PRONTO training for obstetric and neonatal emergencies in Mexico. Int J Gynaecol Obstet Off J Int Fed Gynaecol Obstet 2012, 116:128-133.
• [21]World Health Organization, Maternal and Newborn Health/Safe Motherhood Unit: Care in Normal Birth: A Practical Guide. World Health Organization; 1996:58.
• [22]American Academy of Pediatrics and American Health Association: Neonatal Resuscitation (NRP) Textbook. 6th edition. 2011:329.
• [23]Powell SM: TeamSTEPPS™ - Strategies and Tools to Enhance Performance and Patient Safety : A Collaborative Initiative for Improving Communication and Teamwork in Healthcare. Healthcare Training Team; 2006(Figure 1):5
• [24]Murrugat Mendoza N: Monitoreo Ciudadano de La Politica Publica Federal Para Reducir La Morbimortalidad Materna En Mexico. Foro Nacional de Mujeres y Politicas de Poblacion; 2006:50.
• [25]Cohen SR, Cragin L, Rizk M, Hanberg A, Walker DM: PartoPants™: the high-fidelity, low-tech birth simulator. Clin Simul Nurs 2011, 7:e11-e18.
• [26]Bandura A: Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 1977, 84:191-215.
• [27][http://cape.lpch.org/courses/logistics/skills.html] webcite Center for advanced pediatric and perinatal education: Simulation-based Training: Key behavioral skills. In CAPE; 2012 []
• [28]Hernández-prado B, Hernández-prado BCD, Kestler E, Díaz J, Walker D, Langer A, Lewis S, De V-s E, Melo-zurita MC: Perfil situacional y estrategias de intervención en la región mesoamericana en el área de salud materna, reproductiva y neonatal. Salud Pública Méx 2011, 53(3):312-322.
• [29]Van Lonkhuijzen L, Dijkman A, van Roosmalen J, Zeeman G, Scherpbier A: A systematic review of the effectiveness of training in emergency obstetric care in low-resource environments. BJOG 2010, 117:777-787.