Multidisciplinary team training in a simulation setting for acute obstetric emergencies: a systematic review.
OBJECTIVE
To perform a systematic review of the literature on the effectiveness of multidisciplinary teamwork training in a simulation setting for the reduction of medical adverse outcomes in obstetric emergency situations.


METHODS
We searched Medline, Embase, and the Cochrane Library from inception to June 2009. The search strategy contained medical subject heading terms ("patient care team" and "patient simulation" and "obstetrics" or "gynecology" and "education" or "teaching") and additional text words ("teamwork," "simulation," "training").


METHODS
Studies describing and evaluating teamwork training programs with simulation models for labor ward staff in acute obstetric emergencies were selected. The search revealed 97 articles.


RESULTS
All studies were assessed independently by two reviewers for methodological quality using the quality assessment of diagnostic accuracy studies (QUADAS) criteria. Only eight articles assessed the effect of teamwork training in a simulation setting. Four of them were randomized controlled trials and four were cohort studies. The only study that reported on perinatal outcome showed an improvement in terms of 5-minute Apgar score and hypoxic-ischemic encephalopathy. The seven other studies showed that teamwork training in a simulation setting resulted in improvement of knowledge, practical skills, communication, and team performance in acute obstetric situations. Training in a simulation center did not further improve outcome compared with training in a local hospital.


CONCLUSIONS
Introduction of multidisciplinary teamwork training with integrated acute obstetric training interventions in a simulation setting is potentially effective in the prevention of errors, thus improving patient safety in acute obstetric emergencies. Studies on its effectiveness and cost-effectiveness are needed before team training can be implemented on broad scale.
Merién
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AER
From the Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven; Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam; MMC Academy, Máxima Medical Center, Veldhoven; and Department of Electrical Engineering, University of Technology, Eindhoven, The Netherlands.
van de Ven
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B W
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Houterman
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D004630:Emergencies / Q000451:nursing; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D015402:Nursing Education Research; D009773:Obstetric Nursing / Q000193:education; D010348:Patient Care Team; D011247:Pregnancy; D011248:Pregnancy Complications / Q000451:nursing / Q000628:therapy*; D011256:Pregnancy Outcome; D036301:Qualitative Research; D013663:Teaching / Q000379:methods
Lewis G, Drife J. Why mothers die 2000–2003. The Sixth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. London (UK): RCOG Press; 2004.
Lewis G, Drife J, Botting B. Why mothers die 1997–99. The Fifth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. London (UK): RCOG Press; 2001.
Lewis G, Drife J, Botting B. Why Mothers Die. Report on Confidential Enquiries into Maternal Deaths in the United Kingdom 1994–96. London (UK): The Stationary Office; 1998.
CESDI 5th annual report. London (UK): RCOG Publishing; 1996.
CESDI 6th annual report. London (UK): RCOG Publishing; 1997
CESDI 7th annual report. London (UK): Maternal and Child Health Research Consortium; 2000.
Kohn LT, Corrigan JM, Donaldson M. To err is human: building a safer health system. Institute of Medicine. Washington, DC: National Academy Press; 2000.
Committee on Quality Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Institute of Medicine. Washington, DC: National Academy Press; 2001.
Morey JC, Simon R, Jay GD, Wears RL, Salisbury M, Dukes KA, Berns SD. Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. Health Serv Res 2002;37:1553–81.
Grogan EL, Stiles RA, France DJ, Speroff T, Morris JA, Nixon B, et al. The impact of aviation-based teamwork training on the attitudes of health-care professionals. J Am Coll Surg 2004;199:843–8.
Gaba DM. The future vision of simulation in health care. Qual Saf Health Care 2004;13(suppl 1):i2–10.
Draycott T, Sibanda T, Owen L, Akande V, Winter C, Reading S, Whitelaw A. Does training in obstetric emergencies improve neonatal outcome? BJOG 2006;113:177–82.
Crofts JF, Bartlett C, Ellis D, Hunt LP, Fox R, Draycott TJ. Training for shoulder dystocia: a trial of simulation using low-fidelity and high-fidelity mannequins. Obstet Gynecol 2006;108:1477–85.
Crofts JF, Ellis D, Draycott TJ, Winter C, Hunt LP, Akande VA. Change in knowledge of midwives and obstetric emergency training: a randomized controlled trial of local hospital, simulation centre and teamwork training. BJOG 2007;114:1534–41.
Maslovitz S, Barkai G, Lessing JB, Ziv A, Many A. Recurrent obstetric management mistakes identified by simulation. Obstet Gynecol 2007;109:1295–300.
Birch L, Jones N, Doyle PM, Green P, McLaughlin A, Champney C, et al. Obstetric skills drills: evaluation of teaching methods. Nurse Education Today 2007;27:915–22.
Ellis D, Crofts JF, Hunt LP, Read M, Fox R, James M. Hospital, simulation center, and teamwork training for eclampsia management: a randomized controlled trial. Obstet Gynecol 2008;111:723–31.
Crofts JF, Bartlett C, Ellis D, Winter C, Donald F, Hunt LP, et al. Patient-actor perception of care: a comparison of obstetric emergency training using manikins and patient-actors. Qual Saf Health Care 2008;17:20–4.
Robertson B, Schumacher L, Gosman G, Kanfer R, Kelley M, De Vita M. Simulation-based crisis team training for multidisciplinary obstetric providers. Sim Healthcare 2009;4:77–83.
O'Donnell CP, Kamlin CO, Davis PG, Carlin JB, Morley CJ. Interobserver variability of the 5-minute Apgar score. J Pediatr 2006;149:486–9.
Casey BM, McIntire DD, Leveno KJ. The continuing value of the Apgar score for the assessment of newborn infants. N Engl J Med 2001;344:467–71.
Hübner ME, Juárez ME. The Apgar score. Is it still valid after a half century? Rev Med Chil 2002;130:925–30.
Reznek M, Harter P, Krummel T. Virtual reality and simulation: training the future emergency physician. Acad Emerg Med 2002;9:78–87.
Vozenilek J, Huff JS, Reznek M, Gordan JA. See one, do one, teach one: advanced technology in medical education. Acad Emerg Med 2004;11:1149–54.
Gaba DM, DeAnda A. A comprehensive anesthesia simulation environment: re-creating the operating room for research and training. Anesthesiology 1988;69:387–94.
Bressan F, Buti G, Boncinelli S. Medical simulation in anesthesiology training. Minerva Anestesiol 2007;73:1–11.
Gaba DM, Howard SK, Flanagan B, Smith BE, Fish KJ, Botney R. Assessment of clinical performance during simulated crises using both technical and behavioral ratings. Anesthesiology 1998;89:8–18.
Black RS, Brocklehurst P. A systematic review of training in acute obstetric emergencies. BJOG 2003;110:837–41.
Anderson ER, Black R, Brocklehurst P. Acute obstetric emergency drill in England and Wales: a survey of practice. BJOG 2005;112:372–5.
Nielsen PE, Goldman MB, Mann S, Shapiro DE, Marcus RG, Pratt SD, et al. Effects of teamwork training on adverse outcomes and process of care in labor and delivery: a randomized controlled trial. Obstet Gynecol 2007;109:48–55.