TY - JOUR
T1 - Effect of a cluster randomised team training intervention on adverse perinatal and maternal outcomes: a stepped wedge study
AU - Romijn, A
AU - Ravelli, Anita
AU - de Bruijne, M. C.
AU - Twisk, J.
AU - Wagner, C
AU - de Groot, C
AU - Teunissen, P.W.
PY - 2019/3/1
Y1 - 2019/3/1
N2 - Objective: To study the effect of an intervention based on Crew Resource Management team training, including a tool for structured communication, on adverse perinatal and maternal outcomes. Design: Stepped wedge. Setting: The Netherlands. Population or sample: Registry data of 8123 women referred from primary care to a hospital during childbirth, at ≥ 32.0 weeks of singleton gestation and with no congenital abnormalities, in the period 2012–15. Methods: Obstetric teams of five hospitals and their surrounding primary-care midwifery practices participated in the intervention. In total, 49 team training sessions were organised for 465 care professionals (75.5% participated). Adverse perinatal and maternal outcomes before, during and after the intervention were analysed using multivariate logistic regression analyses. Main Outcome Measures: Adverse Outcome Index (AOI-5), a composite measure involving; intrapartum or neonatal death, admission to neonatal intensive care unit, Apgar < 7 at 5 minutes, postpartum haemorrhage and/or perineal tear. Results: In total, an AOI-5 score was reported in 11.3% of the study population. No significant difference was found in the incidence of the AOI-5 score after the intervention compared with before the intervention (OR 1.07: 95% CI 0.92–1.24). Conclusions: We found no effect of the intervention on adverse perinatal and maternal outcomes for women who were referred during childbirth. Team training is appreciated in practice, but evidence on the long-term impact is still limited. Upcoming studies should build on previous research and consider more sensitive outcome measures. Tweetable abstract: A cluster randomised team training intervention showed no effect on adverse perinatal and maternal outcomes for women referred during childbirth.
AB - Objective: To study the effect of an intervention based on Crew Resource Management team training, including a tool for structured communication, on adverse perinatal and maternal outcomes. Design: Stepped wedge. Setting: The Netherlands. Population or sample: Registry data of 8123 women referred from primary care to a hospital during childbirth, at ≥ 32.0 weeks of singleton gestation and with no congenital abnormalities, in the period 2012–15. Methods: Obstetric teams of five hospitals and their surrounding primary-care midwifery practices participated in the intervention. In total, 49 team training sessions were organised for 465 care professionals (75.5% participated). Adverse perinatal and maternal outcomes before, during and after the intervention were analysed using multivariate logistic regression analyses. Main Outcome Measures: Adverse Outcome Index (AOI-5), a composite measure involving; intrapartum or neonatal death, admission to neonatal intensive care unit, Apgar < 7 at 5 minutes, postpartum haemorrhage and/or perineal tear. Results: In total, an AOI-5 score was reported in 11.3% of the study population. No significant difference was found in the incidence of the AOI-5 score after the intervention compared with before the intervention (OR 1.07: 95% CI 0.92–1.24). Conclusions: We found no effect of the intervention on adverse perinatal and maternal outcomes for women who were referred during childbirth. Team training is appreciated in practice, but evidence on the long-term impact is still limited. Upcoming studies should build on previous research and consider more sensitive outcome measures. Tweetable abstract: A cluster randomised team training intervention showed no effect on adverse perinatal and maternal outcomes for women referred during childbirth.
KW - Adverse outcome index
KW - crew resource management
KW - obstetrics
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85062341170&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30633417
U2 - https://doi.org/10.1111/1471-0528.15611
DO - https://doi.org/10.1111/1471-0528.15611
M3 - Article
C2 - 30633417
SN - 1470-0328
VL - 126
SP - 907
EP - 914
JO - BJOG
JF - BJOG
IS - 7
ER -