Hospital, simulation center, and teamwork training for eclampsia management: a randomized controlled trial.
OBJECTIVE
To compare the effectiveness of training for eclampsia in local hospitals and a regional simulation center, with and without teamwork theory.


METHODS
This study is a randomized controlled trial of training in local hospitals and in a simulation center in the United Kingdom. Midwives and obstetricians working at participating hospitals were randomly assigned to 24 teams. Teams were randomly allocated to training in local hospitals or at a simulation center, and to teamwork theory or not. Performance was evaluated before and after training with a standardized eclampsia scenario captured on video. Outcome measures were completion of tasks, time to completion of tasks, administration of magnesium sulfate, and quality of teamwork.


RESULTS
Training was associated with an increase in completion of basic tasks; 87% before training and 100% afterward. Basic tasks were completed more quickly; 55 seconds compared with 27 seconds, P=.012. The magnesium sulfate loading dose was administered by 61% of teams before training and by 92% afterward (P=.040). There was a shorter median time to administration (116 seconds less; P=.011). Training at the simulation center was not associated with additional improvement. Teamwork generally improved (median global score rose from 2.5 to 4.0; P<.001) but there was no additional benefit from teamwork training.


CONCLUSIONS
Training resulted in enhanced performance with higher rates of completion for basic tasks, shorter times to administration of magnesium sulfate, and improved teamwork. There was no additional benefit from training in a simulation center, and none from teamwork theory.


BACKGROUND
ISRCTN, http://isrctn.org, ISRCTN67906788, reference number 0270030.
Ellis
Denise
D
Department of Obstetrics and Gynaecology, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom.
Crofts
Joanna F
JF
Hunt
Linda P
LP
Read
Mike
M
Fox
Robert
R
James
Mark
M
D002983:Clinical Competence; D004461:Eclampsia / Q000628:therapy*; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D007318:Inservice Training / Q000379:methods*; D008880:Midwifery / Q000193:education*; D010348:Patient Care Team; D016544:Patient Simulation; D011247:Pregnancy; D006113:United Kingdom