Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Dr Detlefs).
Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY (Dr Goffman).
Am J Obstet Gynecol MFM. 2022 Jul;4(4):100626. doi: 10.1016/j.ajogmf.2022.100626. Epub 2022 Mar 26.
Teamwork and communication gaps are consistently cited as contributors to adverse outcomes in obstetrics. The Critical Care in Obstetrics Course provides an innovative experience by combining brief interactive didactics with the opportunity to practice and implement the knowledge gained with hands-on simulation. Most participants have never worked together, which creates a unique environment to evaluate the importance of teamwork and communication.
This study aimed to evaluate the association between teamwork and medical management in high-fidelity critical care simulations.
The participants were separated into multidisciplinary teams and taken through simulations, including placental abruption, hypertensive emergency, eclampsia, sepsis, cardiac arrest, venous thromboembolism, diabetic ketoacidosis, and thyroid storm. Facilitators completed a validated checklist assessment for each group's performance in medical care and teamwork. Each element was rated on a scale from 1 to 5, with 1 being unacceptable and 5 being perfect. We evaluated 5 communication measures, including the use of closed-loop communication and orientation of new team members. A Spearman correlation was used to evaluate the relationship between total medical management and total teamwork scores and specific measures of team communication. Receiver operating characteristic curves were created for total teamwork score as a predictor of good or perfect medical management.
A total of 354 multidisciplinary teams participated in 1564 high-fidelity simulations. There was a significant correlation between medical management and teamwork and communication scores for all scenarios. The strongest correlation was for the total teamwork score for all simulations (ρ=0.84). Teamwork scores were highly predictive of medical management scores with an area under the curve of at least 0.88 for all simulations, although this was not significant for diabetic ketoacidosis.
The quality of teamwork and communication correlated with the quality of clinical performance in newly formed multidisciplinary teams. This demonstrates the importance of teamwork training, with a focus on key communication tools and strategies, among medical providers to optimize the management of complex and emergent obstetrical conditions.
团队合作和沟通差距一直被认为是导致产科不良结果的因素。《产科重症监护课程》通过将简短的互动教学与实践机会相结合，提供了一种创新的体验，使参与者有机会练习和实施通过实践获得的知识。大多数参与者从未一起工作过，这为评估团队合作和沟通的重要性创造了一个独特的环境。
本研究旨在评估高保真重症监护模拟中团队合作与医疗管理之间的关联。
参与者被分成多学科团队，并进行模拟，包括胎盘早剥、高血压急症、子痫、脓毒症、心脏骤停、静脉血栓栓塞、糖尿病酮症酸中毒和甲状腺危象。协调员为每个团队的医疗保健和团队合作表现完成一份经过验证的清单评估。每个元素的评分范围为 1 到 5，1 表示不可接受，5 表示完美。我们评估了 5 项沟通措施，包括使用闭环沟通和新团队成员的方向。使用 Spearman 相关系数评估总医疗管理与总团队合作评分以及团队沟通特定措施之间的关系。创建了总团队合作评分作为良好或完美医疗管理的预测指标的接收器工作特征曲线。
共有 354 个多学科团队参加了 1564 次高保真模拟。所有场景中医疗管理与团队合作和沟通评分之间存在显著相关性。所有模拟中最强的相关性是总团队合作评分（ρ=0.84）。团队合作评分高度预测医疗管理评分，所有模拟的曲线下面积至少为 0.88，尽管对于糖尿病酮症酸中毒则不显著。
新组建的多学科团队中，团队合作和沟通的质量与临床绩效的质量相关。这表明，团队合作培训的重要性，重点是医疗提供者之间的关键沟通工具和策略，以优化复杂和紧急产科情况的管理。
