Lavelle Mary, Abthorpe Jennifer, Simpson Thomas, Reedy Gabriel, Little Fiona, Banerjee Anita
a The Florence Nightingale Faculty of Nursing and Midwifery , King's College London , London , UK.
b Simulation and Interactive Learning Centre Guy's and St. Thomas' NHS Foundation Trust , London , UK.
J Obstet Gynaecol. 2018 Aug;38(6):781-788. doi: 10.1080/01443615.2017.1419339. Epub 2018 Mar 21.
The majority of maternal deaths in the UK are due to pre-existing or new-onset medical conditions, known as 'indirect deaths'. The MBRRACE report identified serious gaps in clinicians' human factors skills, including communication, leadership and teamwork, which contributed to maternal death. In response, we developed the first multi-disciplinary simulation-based training programme designed to address Medical Emergencies in Obstetrics (MEmO). Employing a mixed methods design, this study evaluated the educational impact of this training programme on the healthcare staff (n = 140), including the medical doctors (n = 91) and the midwives (n = 49). The training improved participants' clinical management of medical deterioration in pregnancy (p=.003) alongside improving their human factors skills (p=.004). Furthermore, participants reported the translation of these skills to their routine clinical practice. This flexible training is responsive to the changing national needs and contextualises the MBRRACE findings for healthcare staff. It is a promising avenue for reducing the rates of in-direct death in pregnancy. Impact statement What is already known on this subject? The majority of maternal deaths in the UK are due to pre-existing or new-onset medical conditions. The management of medical conditions in pregnancy relies on a multi-professional approach. However, serious gaps in clinicians' human factors skills, highlighted by the MBRRACE report, may contribute to maternal death. What do the results of this study add? This study evaluated the first multi-disciplinary, simulation-based training programme designed to address Medical Emergencies in Obstetrics (MEmO). Training significantly improved participants' management of medical deterioration in pregnancy and human factors skills, particularly in the areas of leadership, communication and teamwork. Moreover, the participants learning translated into their clinical practice. What are the implications of these findings for clinical practice and/or further research? The delivery of multi-disciplinary team training for all healthcare staff involved in the complex management of medical conditions in pregnancy can help develop a greater understanding of others' professional roles, and demonstrate the importance of interprofessional teamwork. Furthermore, it provides the space to reflect on team working approaches, including the leadership and professional autonomy, and their potential impact on patient care. Future research should evaluate the impact of this training on the objective outcome measures of medical emergencies in pregnancy.
英国大多数孕产妇死亡是由既往存在的或新出现的疾病状况导致的，即所谓的“间接死亡”。MBRRACE报告指出临床医生在包括沟通、领导力和团队合作等人为因素技能方面存在严重差距，这些差距导致了孕产妇死亡。作为回应，我们开发了首个基于模拟的多学科培训项目，旨在应对产科医疗紧急情况（MEmO）。本研究采用混合方法设计，评估了该培训项目对医护人员（n = 140）的教育影响，其中包括医生（n = 91）和助产士（n = 49）。培训改善了参与者对孕期病情恶化的临床管理（p = .003），同时也提高了他们的人为因素技能（p = .004）。此外，参与者报告称这些技能已转化到他们的日常临床实践中。这种灵活的培训能够响应不断变化的国家需求，并将MBRRACE的调查结果与医护人员的实际情况相结合。它是降低孕期间接死亡率的一个有前景的途径。影响声明关于这个主题已知的信息有哪些？英国大多数孕产妇死亡是由既往存在的或新出现的疾病状况导致的。孕期疾病的管理依赖多专业方法。然而，MBRRACE报告强调的临床医生在人为因素技能方面的严重差距可能导致孕产妇死亡。本研究的结果补充了什么？本研究评估了首个旨在应对产科医疗紧急情况（MEmO）的基于模拟的多学科培训项目。培训显著改善了参与者对孕期病情恶化的管理以及人为因素技能，特别是在领导力、沟通和团队合作方面。此外，参与者的学习转化到了他们的临床实践中。这些发现对临床实践和/或进一步研究有什么意义？为所有参与孕期复杂疾病管理的医护人员提供多学科团队培训，有助于增进对他人专业角色的理解，并证明跨专业团队合作的重要性。此外，它提供了反思团队工作方式的空间，包括领导力和专业自主性及其对患者护理的潜在影响。未来的研究应评估该培训对孕期医疗紧急情况客观结果指标的影响。
