The effect of simulation-based obstetric team training

The main objective of dr. Truijens' thesis is to contribute to the exploration of patient-reported outcomes in perinatal care by focusing on developing and validating questionnaires, evaluating the quality of perinatal care, evaluating the effect of simulation-based team training on patient reported quality of care, and assessing aspects of mental health during pregnancy. In this blog post dr. Truijens will tell us more about her study, and share her insights.

During the last decade, there has been a growing interest in patient-centered health care, with perceived quality of care and patient satisfaction becoming important indicators of care quality. Therefore, patient-reported quality of care is also becoming more important as an outcome measure of training and education. This blog is about patient-reported quality of care as an outcome measure of multiprofessional simulation-based team training in obstetrics.

Team training in health care

A review of Weaver and colleagues (2014) concluded that team training in health care improves teamwork processes and can positively impact patient outcomes. Some previous studies have also shown that simulation-based obstetric team training improves team performance (Ellis et al., 2008; Fransen et al., 2012) and might improve perinatal outcomes (Draycott et al., 2006; Goffman et al., 2014).

However, since no previous research has focused on the effect of simulation-based obstetric team training on patient-reported quality of care, we performed an experimental study on this topic (Truijens et al., 2015).

Teamwork skills

Multiprofessional teams from a large obstetric collaborative network in the area of the Máxima Medical Centre Veldhoven in the southern part of The Netherlands were trained in teamwork skills using the principles of Crew Resource Management (CRM).

During five one-day trainings, 80 care providers of the obstetric collaborative network were trained in teams of approximately 16 health care professionals, including: 2 ambulance staff, 2 maternity nurses, 4 to 5 independent community midwives, 2 obstetric nurses, 2 hospital midwives, 2 residents, and 2 obstetricians.

Before the start of the scenarios, the teams received an explanation concerning the equipment and environment of the simulation rooms. The scenarios started with a short introductory briefing video with actors mimicking the medical situation and providing some background information about the simulated patient.

Thereafter, the participants moved to the simulation room where they managed the simulated patient (Noelle, Gaumard Scientific, Miami, FL). The scenarios were approximately 15 minutes each, were all videotaped, and the recordings were used to facilitate the debriefing after each scenario.

 The debriefings of approximately 45 minutes were facilitated by a communication trainer and an obstetrician who were educated in facilitating simulation-based team training. The trainers provided feedback on both technical and non-technical skills using the video-recordings, with a focus on standardized communication and handovers based on the SBAR system of communication.

Quality of care

To measure the quality of care as perceived by patients, the validated Pregnancy and Childbirth Questionnaire (PCQ, Truijens et al., 2014) with 25 items on a 5-point Likert scale was assessed in a group of 76 postpartum women prior to the training, and another group of 68 postpartum women at three months after the training. The two groups of postpartum women showed comparable characteristics.

At the evaluation assessment three months after the training, the mean quality of care score measured with the PCQ was significantly higher compared to the group of women who filled out the questionnaire before the simulation-based team trainings. The questionnaire items with the largest increase in mean scores were found to be about communication between health care professionals, clear leadership, involvement in planning, and better provision of information.

Simulation-based obstetric team training is effective

Despite the methodological restrictions of this pilot study and its non-randomized design, the results indicate that multiprofessional simulation-based obstetric team training seems to improve patient-reported quality of care. The possibility that this improvement relates to the training is supported by the fact that the items with the largest increase are about the principles of Crew Resource Management, used in the training.

In summary, the results of this pilot study showed a higher score on patient-reported quality of care after multiprofessional simulation-based obstetric team training. Taking into account the limitations of the study design, this study contributes to the field of research that evaluates the effects of simulation-based obstetric team training on patient outcome level and will hopefully stimulate further research and deliberate practice using simulation-based education.

More details about this study can be found elsewhere: Truijens S.E.M.; Banga F.R.; Fransen A.F.; Pop V.J.M.; Runnard Heimel P.J. van; Oei S.G. (2015). The effect of multiprofessional simulation-based obstetric team training on patient-reported quality of care: a pilot study. Simulation in Healthcare, 10, 210-6.

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References

• Weaver S.J.; Dy S.M., Rosen M.A. (2014). Team-training in health care: a narrative synthesis of the literature. BMJ Qual Saf, 23, 359-72.
• Ellis D., Crofts J.F., Hunt L.P., Read M., Fox R., James M. (2008). Hospital, simulation center, and teamwork training for eclampsia management: a randomized controlled trial. Obstet Gynecol, 111, 723-31.
• Fransen A.F.; Ven J. van de; Merién A.E.R.; De Wit-Zuurendonk L.D.; Houterman S.; Mol B.W.; Oei S.G. (2012). Effect of obstetric team training on team performance and medical technical skills: a randomised controlled trial. BJOG, 119, 1387-93.
• Draycott T.; Sibanda T.; Owen L.; Akande V.; Winter C.; Reading S.; Whitelaw A. (2006). Does training in obstetric emergencies improve neonatal outcome? BJOG, 113, 177-82.
• Goffman D.; Brodman M.; Friedman A.J.; Minkoff H.; Merkatz I.R. (2014). Improved obstetric safety through programmatic collaboration. J Healthc Risk Manag, 33, 14-22.
• Truijens S.E.M.; Pommer A.M.; Runnard Heimel P.J. van; Verhoeven C.J.M.; Oei S.G.; Pop V.J.M. (2014). 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, 174, 35-40.
• Truijens S.E.M.; Banga F.R.; Fransen A.F.; Pop V.J.M.; Runnard Heimel P.J. van; Oei S.G. (2015). The effect of multiprofessional simulation-based obstetric team training on patient-reported quality of care: a pilot study. Simulation in Healthcare, 10, 210-6.
• Truijens S.E.M.; Pommer A.M.; Runnard Heimel P.J. van; Verhoeven C.J.M.; Oei S.G.; Pop V.J.M. (2014). 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, 174, 35-40.