Crofts J F, Bartlett C, Ellis D, Winter C, Donald F, Hunt L P, Draycott T J
The SaFE Study, Department of Obstetrics and Gynaecology, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK.
Qual Saf Health Care. 2008 Feb;17(1):20-4. doi: 10.1136/qshc.2006.021873.
To explore the effect of training on patient-actor perception of care during simulated obstetric emergencies.
A subanalysis from a prospective randomised controlled trial in six UK hospitals and the Bristol Medical Simulation Centre, UK. Midwives and doctors working in participating hospitals were eligible for inclusion. 140 participants (22 junior and 23 senior doctors, 47 junior and 48 senior midwives) were randomised to one of four obstetric emergency training interventions: 1-day course at local hospitals; 1-day course at simulation centre; 2-day course with teamwork training at local hospitals; and 2-day course with teamwork training at simulation centre. Local training used patient-actors and low-fidelity part-task trainers whereas simulation centre training used full-bodied computerised manikins and high-fidelity part-task trainers. Three weeks before and after the training, the participants managed three simulated obstetric emergencies. Patient-actors scored their care after each simulation using a patient-actor perception score (communication, safety, respect).
The following numbers of scores were awarded: 139 and 132 participant and 46 and 48 team scenarios, before and after training, respectively. There was a significant improvement in all scores in all scenarios after the training (p = 0.017 to >0.001). Perception of safety and communication during postpartum haemorrhage was significantly improved following training with patient-actors compared with training with manikins (safety p = 0.048, communication p = 0.035). Teamwork training offered no additional benefit to patient-actors' perception of their care.
All multiprofessional training improved patient-actor perception of care. Training using a patient-actor may be better at improving perception of safety and communication than training with a computerised manikin simulator.
探讨培训对模拟产科紧急情况中患者扮演者护理感知的影响。
对英国六家医院和英国布里斯托尔医学模拟中心进行的一项前瞻性随机对照试验进行亚分析。参与医院的助产士和医生符合纳入条件。140名参与者（22名初级医生和23名高级医生、47名初级助产士和48名高级助产士）被随机分配到四种产科紧急情况培训干预措施之一：当地医院的1天课程；模拟中心的1天课程；当地医院的2天团队合作培训课程；模拟中心的2天团队合作培训课程。当地培训使用患者扮演者和低保真部分任务训练器，而模拟中心培训使用全身计算机化人体模型和高保真部分任务训练器。培训前后三周，参与者处理了三次模拟产科紧急情况。患者扮演者在每次模拟后使用患者扮演者护理感知评分（沟通、安全、尊重）对他们的护理进行评分。
培训前后分别有139和132名参与者以及46和48个团队场景获得评分。培训后所有场景的所有评分均有显著改善（p = 0.017至>0.001）。与使用人体模型培训相比，使用患者扮演者培训后，产后出血期间的安全和沟通感知有显著改善（安全p = 0.048，沟通p = 0.035）。团队合作培训对患者扮演者对其护理的感知没有额外益处。
所有多专业培训均改善了患者扮演者对护理的感知。与使用计算机化人体模型模拟器培训相比，使用患者扮演者培训在改善安全和沟通感知方面可能更好。
