title: Team training in obstetric and neonatal emergencies using highly realistic simulation in Mexico: impact on process indicators.
abstract: BACKGROUND
  Ineffective management of obstetric emergencies contributes significantly to maternal and neonatal morbidity and mortality in Mexico. PRONTO (Programa de Rescate Obstétrico y Neonatal: Tratamiento Óptimo y Oportuno) is a highly-realistic, low-tech simulation-based obstetric and neonatal emergency training program. A pair-matched hospital-based controlled implementation trial was undertaken in three states in Mexico, with pre/post measurement of process indicators at intervention hospitals. This report assesses the impact of PRONTO simulation training on process indicators from the pre/post study design for process indicators.
  
  
  METHODS
  Data was collected in twelve intervention facilities on process indicators, including pre/post changes in knowledge and self-efficacy of obstetric emergencies and neonatal resuscitation, achievement of strategic planning goals established during training and changes in teamwork scores. Authors performed a longitudinal fixed-effects linear regression model to estimate changes in knowledge and self-efficacy and logistic regression to assess goal achievement.
  
  
  RESULTS
  A total of 450 professionals in interprofessional teams were trained. Significant increases in knowledge and self-efficacy were noted for both physicians and nurses (p <0.001- 0.009) in all domains. Teamwork scores improved and were maintained over a three month period. A mean of 58.8% strategic planning goals per team in each hospital were achieved. There was no association between high goal achievement and knowledge, self-efficacy, proportion of doctors or nurses in training, state, or teamwork score.
  
  
  CONCLUSIONS
  These results suggest that PRONTO's highly realistic, locally appropriate simulation and team training in maternal and neonatal emergency care may be a promising avenue for optimizing emergency response and improving quality of facility-based obstetric and neonatal care in resource-limited settings.
  
  
  BACKGROUND
  NCT01477554.
authors.affiliation: Department of Global Health, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98104, USA. dilys@uw.edu.|Department of Obstetrics and Gynecology, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98104, USA. dilys@uw.edu.
authors.forename: Dilys
authors.initials: D
authors.lastname: Walker
authors.affiliation: College of Nursing, University of Utah, 10 South 2000, East Salt Lake City, UT, 84112, USA. susanna.cohen@nurs.utah.edu.
authors.forename: Susanna
authors.initials: S
authors.lastname: Cohen
authors.affiliation: Division of Reproductive Health, Research Center for Population Health, National Institute of Public Health, Universidad No 655 Col Santa Maria Ahuacatitlan, Cerrada los Pinos y Caminera, CP, 621000, Cuernavaca, Mexico. jimena.fritz@insp.mx.
authors.forename: Jimena
authors.initials: J
authors.lastname: Fritz
authors.affiliation: Division of Reproductive Health, Research Center for Population Health, National Institute of Public Health, Universidad No 655 Col Santa Maria Ahuacatitlan, Cerrada los Pinos y Caminera, CP, 621000, Cuernavaca, Mexico. marisela.olvera@insp.mx.
authors.forename: Marisela
authors.initials: M
authors.lastname: Olvera
authors.affiliation: Division of Reproductive Health, Research Center for Population Health, National Institute of Public Health, Universidad No 655 Col Santa Maria Ahuacatitlan, Cerrada los Pinos y Caminera, CP, 621000, Cuernavaca, Mexico. hlamadrid@insp.mx.
authors.forename: Hector
authors.initials: H
authors.lastname: Lamadrid-Figueroa
authors.affiliation: Clinical Faculty, Department of Family Medicine, Swedish Hospital, 747 Broadway, Seattle, WA, 98122, USA. jessicafreya@gmail.com.
authors.forename: Jessica Greenberg
authors.initials: JG
authors.lastname: Cowan
authors.affiliation: Division of Reproductive Health, Research Center for Population Health, National Institute of Public Health, Universidad No 655 Col Santa Maria Ahuacatitlan, Cerrada los Pinos y Caminera, CP, 621000, Cuernavaca, Mexico. dgonzale@insp.mx.
authors.forename: Dolores Gonzalez
authors.initials: DG
authors.lastname: Hernandez
authors.affiliation: Department of Global Health, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98104, USA. jcdettin@uw.edu.
authors.forename: Julia C
authors.initials: JC
authors.lastname: Dettinger
authors.affiliation: Department of Obstetrics and Gynecology, University of Maryland School of Medicine, 22 S Green St, Baltimore, MD, 12201, USA. jfahey@fpi.umaryland.edu.
authors.forename: Jenifer O
authors.initials: JO
authors.lastname: Fahey
mesh_terms: D000328:Adult; D004630:Emergencies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000628:therapy*; D007318:Inservice Training / Q000379:methods*; D008297:Male; D008800:Mexico; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000175:diagnosis / Q000628:therapy*; D009937:Organizational Objectives; D010348:Patient Care Team / Q000458:organization & administration; D011247:Pregnancy; D017064:Process Assessment, Health Care; D019984:Quality Indicators, Health Care; D012151:Resuscitation / Q000193:education; D020377:Self Efficacy; D055815:Young Adult