Sonesh Shirley C, Gregory Megan E, Hughes Ashley M, Feitosa Jennifer, Benishek Lauren E, Verhoeven Dana, Patzer Brady, Salazar Maritza, Gonzalez Laura, Salas Eduardo
Institute for Simulation & Training and Department of Psychology, University of Central Florida.
Department of Psychology, University of Central Florida.
Fam Syst Health. 2015 Sep;33(3):250-61. doi: 10.1037/fsh0000148.
Obstetric complications and adverse patient events are often preventable. Teamwork and situational awareness (SA) can improve detection and coordination of critical obstetric (OB) emergencies, subsequently improving decision making and patient outcomes. The purpose of this study was to assess the effectiveness of a team training intervention in improving learning and transfer of teamwork, SA, decision making, and cognitive bias as well as patient outcomes in OB.
An adapted TeamSTEPPS training program was delivered to OB clinicians. Training targeted communication, mutual support, situation monitoring, leadership, SA, and cognitive bias. We conducted a repeated measures multilevel evaluation of the training using Kirkpatrick's (1994) framework of training evaluation to determine impact on trainee reactions, learning, transfer, and results. Data were collected using surveys, situational judgment tests (SJTs), observations, and patient chart reviews.
Participants perceived the training as useful. Additionally, participants acquired knowledge of communication strategies, though knowledge of other team competencies did not significantly improve nor did self-reported teamwork on the unit. Although SJT decision accuracy did not significantly improve for all scenarios, results of behavioral observation suggest that decision accuracy significantly improved on the job, and there was a marginally significant reduction in babies' hospital length of stay.
These findings indicate that the training intervention was partially effective, but more work needs to be done to determine the conditions under which training is most effective, and the ways in which to sustain improvements. Future research is needed to confirm its generalizability to additional OB units and departments.
产科并发症和不良患者事件往往是可以预防的。团队合作和情景意识（SA）可以改善对关键产科（OB）紧急情况的发现和协调，进而改善决策制定和患者结局。本研究的目的是评估团队培训干预在改善团队合作、情景意识、决策制定和认知偏差的学习与转化以及产科患者结局方面的有效性。
为产科临床医生提供了一个改编后的团队策略与工具（TeamSTEPPS）培训项目。培训的目标是沟通、相互支持、情景监测、领导力、情景意识和认知偏差。我们使用柯克帕特里克（1994）的培训评估框架对培训进行了重复测量多层次评估，以确定对学员反应、学习、转化和结果的影响。数据通过调查、情景判断测试（SJT）、观察和患者病历审查收集。
参与者认为培训很有用。此外，参与者获得了沟通策略方面的知识，不过其他团队能力方面的知识没有显著提高，单位内自我报告的团队合作也没有显著改善。虽然并非所有情景下SJT决策准确性都有显著提高，但行为观察结果表明工作中的决策准确性有显著提高，并且婴儿住院时间略有显著缩短。
这些发现表明培训干预部分有效，但需要做更多工作来确定培训最有效的条件以及维持改进的方法。未来需要进行研究以确认其对其他产科单位和部门的可推广性。
