产科模拟培训与团队协作：对知识、团队协作及出血方案依从性的即时影响

Obstetric Simulation Training and Teamwork: Immediate Impact on Knowledge, Teamwork, and Adherence to Hemorrhage Protocols.

作者信息

Greer Joy A, Lutgendorf Monica A, Ennen Christopher S, Van Petten Lauren, Modzik Adrian, Salas Dominick, Fish Jessica, Middlebrooks Reginald, Spalding Carmen N, Delorey Donald R

机构信息

From the Healthcare Simulation and Bioskills Training Center (J.A.G., L.V.P., A.M., D.R.D.), and Department of Gynecologic Surgery and Obstetrics, Naval Medical Center, Portsmouth, VA (J.A.G., C.S.E.); Department of Gynecologic Surgery and Obstetrics (J.A.G., M.A.L.), Uniformed Services University of Health Sciences, Bethesda, MD; Department of Gynecologic Surgery and Obstetrics (M.A.L., D.S., J.F.), Naval Medical Center, San Diego, CA; Department of Anesthesia, Naval Medical Center, Portsmouth, VA (R.M.); and Bioskills (C.N.S.), Simulation Training Center, Naval Medical Center, San Diego, CA.

出版信息

Simul Healthc. 2023 Feb 1;18(1):32-41. doi: 10.1097/SIH.0000000000000641. Epub 2022 Feb 9.

DOI:10.1097/SIH.0000000000000641

PMID:35136007

Abstract

INTRODUCTION

The Obstetric Simulation Training and Teamwork (OB-STaT) curriculum was an in situ interprofessional program to provide standardized postpartum hemorrhage (PPH) simulation training throughout a health system to decrease PPH morbidity. In this study portion, investigators hypothesized that OB-STaT would increase: (a) team member knowledge in diagnosis and management of PPH, (b) teamwork, (c) adherence to established PPH protocols, and (d) patient satisfaction.

METHODS

The OB-STaT was implemented at 8 US Navy hospitals between February 2018 and November 2019. Participant PPH treatment and maternal/neonatal resuscitation pretraining/posttraining knowledge was assessed via an 11-item test, whereas teamwork and standardized patient assessment were rated using validated Likert-type scales: the 15-item Clinical Teamwork Scale and 3-item Patient Perception Score, with item ranges of 0 to 10 and 0 to 5, respectively. Local PPH protocol adherence was assessed using role-specific checklists, with a potential maximum of 14 points (anesthesia/nursing) or 22 points (obstetrics).

RESULTS

Fifty-four interprofessional teams participated. Obstetricians (trainees and attendings) demonstrated significantly improved knowledge test scores (8.33 ± 1.6 vs. 8.66 ± 1.5, P < 0.01). Between the 2 scenarios, overall mean Clinical Teamwork Scale scores improved significantly for all interprofessional teams (5.82 ± 2.0 vs. 7.25 ± 1.9, P < 0.01). Anesthesia, nursing, and obstetric subteams demonstrated significant increases in protocol adherence as measured by critical action scores (12.28 ± 1.7 vs. 13.56 ± 1.0, 12.43 ± 1.6 vs. 13.14 ± 1.3, and 18.14 ± 2.7 vs. 19.56 ± 2.1 respectively, all P < 0.02). Although overall standardized patient satisfaction did not significantly improve, scores for feeling well informed did (3.36 ± 1.0 vs. 3.76 ± 0.8, P < 0.01).

CONCLUSIONS

The OB-STaT curriculum modestly improved participants' teamwork, communication, and protocol adherence during simulated PPH scenarios; OB-STaT may decrease PPH morbidity.

摘要

简介

产科模拟培训与团队协作（OB-STaT）课程是一项现场跨专业项目，旨在为整个医疗系统提供标准化的产后出血（PPH）模拟培训，以降低PPH的发病率。在本研究部分，研究人员假设OB-STaT将提高：（a）团队成员在PPH诊断和管理方面的知识，（b）团队协作，（c）对既定PPH协议的遵守情况，以及（d）患者满意度。

方法

2018年2月至2019年11月期间，在美国8家海军医院实施了OB-STaT。通过一项11项测试评估参与者的PPH治疗以及孕产妇/新生儿复苏培训前/培训后的知识，而团队协作和标准化患者评估则使用经过验证的李克特量表进行评分：15项临床团队协作量表和3项患者感知评分，项目范围分别为0至10分和0至5分。使用特定角色清单评估当地PPH协议的遵守情况，麻醉/护理的潜在最高分是14分，产科是22分。

结果

54个跨专业团队参与其中。产科医生（实习生和主治医生）的知识测试成绩有显著提高（8.33±1.6对8.66±1.5，P<0.01）。在两种场景之间，所有跨专业团队的临床团队协作量表总体平均得分有显著提高（5.82±2.0对7.25±1.9，P<0.01）。麻醉、护理和产科子团队在关键行动得分方面显示出协议遵守情况的显著提高（分别为12.28±1.7对13.56±1.0、12.43±1.6对13.14±1.3、18.14±2.7对19.56±2.1，均P<0.02）。虽然总体标准化患者满意度没有显著提高，但患者对信息充分了解的满意度得分有所提高（3.36±1.0对3.76±0.8，P<0.01）。