title: Simulation-based team training for multi-professional obstetric care teams to improve patient outcome: a multicentre, cluster randomised controlled trial.
abstract: To investigate whether simulation-based obstetric team training in a simulation centre improves patient outcome.
  
  
  
  Multicentre, open, cluster randomised controlled trial.
  
  
  
  Obstetric units in the Netherlands.
  
  
  
  Women with a singleton pregnancy beyond 24 weeks of gestation.
  
  
  
  Random allocation of obstetric units to a 1-day, multi-professional, simulation-based team training focusing on crew resource management (CRM) in a simulation centre or to no such team training. Intention-to-treat analyses were performed at the cluster level, including a measurement 1 year prior to the intervention.
  
  
  
  Primary outcome was a composite outcome of obstetric complications during the first year post-intervention, including low Apgar score, severe postpartum haemorrhage, trauma due to shoulder dystocia, eclampsia and hypoxic-ischaemic encephalopathy. Maternal and perinatal mortality were also registered.
  
  
  
  Each study group included 12 units with a median unit size of 1224 women, combining for a total of 28 657 women. In total, 471 medical professionals received the training course. The composite outcome of obstetric complications did not differ between study groups [odds ratio (OR) 1.0, 95% confidence interval (CI) 0.80-1.3]. Team training reduced trauma due to shoulder dystocia (OR 0.50, 95% CI 0.25-0.99) and increased invasive treatment for severe postpartum haemorrhage (OR 2.2, 95% CI 1.2-3.9) compared with no intervention. Other outcomes did not differ between study groups.
  
  
  
  A 1-day, off-site, simulation-based team training, focusing on teamwork skills, did not reduce a composite of obstetric complications.
  
  
  
  1-day, off-site, simulation-based team training did not reduce a composite of obstetric complications.
authors.affiliation: Department of Obstetrics and Gynaecology, Máxima Medical Centre, Eindhoven-Veldhoven, the Netherlands.|Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: A F
authors.initials: AF
authors.lastname: Fransen
authors.affiliation: Department of Obstetrics and Gynaecology, Máxima Medical Centre, Eindhoven-Veldhoven, the Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: van de Ven
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.|Stanford Prevention Research Center, Stanford University, Stanford, California, USA.
authors.forename: E
authors.initials: E
authors.lastname: Schuit
authors.affiliation: Department of Obstetrics and Gynaecology, Máxima Medical Centre, Eindhoven-Veldhoven, the Netherlands.
authors.forename: Aac
authors.initials: A
authors.lastname: van Tetering
authors.affiliation: The Robinson Institute, School of Paediatrics and Reproductive Health University of Adelaide and the South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
authors.forename: B W
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Department of Obstetrics and Gynaecology, Máxima Medical Centre, Eindhoven-Veldhoven, the Netherlands.|Department of Electrotechnical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
authors.forename: S G
authors.initials: SG
authors.lastname: Oei
mesh_terms: D004630:Emergencies; D005260:Female; D006801:Humans; D009426:Netherlands; D010348:Patient Care Team; D054238:Perinatal Mortality; D006473:Postpartum Hemorrhage; D011247:Pregnancy
keywords: Multi-professional training; obstetric care; patient outcome; simulation; team training; teamwork skills