Gallagher Gillian, Griffin Alison, Clipperton Sharon, Janssens Sarah
Mater Misericordiae Ltd Brisbane, South Brisbane, Queensland, Australia.
The University of Queensland, Saint Lucia, Queensland, Australia.
BMJ Simul Technol Enhanc Learn. 2021 Jun 16;7(6):543-547. doi: 10.1136/bmjstel-2021-000860. eCollection 2021.
Umbilical cord prolapse is a rare obstetric emergency requiring rapid coordination of a multidisciplinary team to effect urgent delivery. The decision to delivery interval (DDI) is a marker of quality of teamwork. Multidisciplinary team simulation-based training can be used to improve clinical and teamwork performance.
To assess the DDI for cord prolapse before and after the introduction of simulation-based training at a quaternary maternity unit in Australia.
A retrospective, observational cohort study comparing the DDI before and after the introduction of simulation-based training activities. The general linear model was used to estimate the association between DDI and simulation training while adjusting for potential confounders including model of care (public or private) and time of birth (regular or after hours).
After the introduction of simulation training, mean DDI decreased by 4.1 min (difference -4.1, 95% CI -6.2 to -1.9), after adjustment for confounding factors. Despite this, there was no difference in selected neonatal outcomes including Apgar score at 5 min and arterial cord pH.
The introduction of simulation-based training was associated with a decrease in the DDI in the setting of cord prolapse.
脐带脱垂是一种罕见的产科急症，需要多学科团队迅速协作以实现紧急分娩。决定分娩间隔（DDI）是团队协作质量的一个指标。基于多学科团队模拟的培训可用于提高临床和团队协作表现。
评估在澳大利亚一家四级产科单位引入基于模拟的培训前后脐带脱垂的DDI。
一项回顾性观察队列研究，比较引入基于模拟的培训活动前后的DDI。使用一般线性模型估计DDI与模拟培训之间的关联，同时对潜在混杂因素进行调整，包括护理模式（公立或私立）和出生时间（正常时间或非工作时间）。
在引入模拟培训后，经混杂因素调整后，平均DDI缩短了4.1分钟（差值-4.1, 95%CI -6.2至-1.9）。尽管如此，在选定的新生儿结局方面没有差异，包括5分钟时的阿氏评分和脐动脉血pH值。
在脐带脱垂情况下，引入基于模拟的培训与DDI缩短有关。
