title: The impact of transmural multiprofessional simulation-based obstetric team training on perinatal outcome and quality of care in the Netherlands.
abstract: BACKGROUND
  Perinatal mortality and morbidity in the Netherlands is relatively high compared to other European countries. Our country has a unique system with an independent primary care providing care to low-risk pregnancies and a secondary/tertiary care responsible for high-risk pregnancies. About 65% of pregnant women in the Netherlands will be referred from primary to secondary care implicating multiple medical handovers. Dutch audits concluded that in the entire obstetric collaborative network process parameters could be improved. Studies have shown that obstetric team training improves perinatal outcome and that simulation-based obstetric team training implementing crew resource management (CRM) improves team performance. In addition, deliberate practice (DP) improves medical skills. The aim of this study is to analyse whether transmural multiprofessional simulation-based obstetric team training improves perinatal outcome.
  
  
  METHODS
  The study will be implemented in the south-eastern part of the Netherlands with an annual delivery rate of over 9,000. In this area secondary care is provided by four hospitals. Each hospital with referring primary care practices will form a cluster (study group). Within each cluster, teams will be formed of different care providers representing the obstetric collaborative network. CRM and elements of DP will be implemented in the training. To analyse the quality of care as perceived by patients, the Pregnancy and Childbirth Questionnaire (PCQ) will be used. Furthermore, self-reported collaboration between care providers will be assessed. Team performance will be measured by the Clinical Teamwork Scale (CTS). We employ a stepped-wedge trial design with a sequential roll-out of the trainings for the different study groups.Primary outcome will be perinatal mortality and/or admission to a NICU. Secondary outcome will be team performance, quality of care as perceived by patients, and collaboration among care providers.
  
  
  CONCLUSIONS
  The effect of transmural multiprofessional simulation-based obstetric team training on perinatal outcome has never been studied. We hypothesise that this training will improve perinatal outcome, team performance, and quality of care as perceived by patients and care providers.
  
  
  BACKGROUND
  The Netherlands National Trial Register, http://www.trialregister.nl/NTR4576, registered June 1, 2014.
authors.affiliation: Department of Obstetrics and Gynaecology, Máxima Medical Centre, De Run 4600, P,O, Box 7777, Veldhoven, 5500 MB, The Netherlands. f.banga@mmc.nl.
authors.forename: Franyke R
authors.initials: FR
authors.lastname: Banga
authors.forename: Sophie E M
authors.initials: SE
authors.lastname: Truijens
authors.forename: Annemarie F
authors.initials: AF
authors.lastname: Fransen
authors.forename: Jeanne P
authors.initials: JP
authors.lastname: Dieleman
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: van Runnard Heimel
authors.forename: Guid S
authors.initials: GS
authors.lastname: Oei
mesh_terms: D002423:Cause of Death; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D033183:Interdisciplinary Communication; D009426:Netherlands; D009774:Obstetrics / Q000193:education*; D010348:Patient Care Team; D054238:Perinatal Mortality; D011247:Pregnancy; D058996:Quality Improvement / Q000458:organization & administration