University Hospital Ulm, Department of Gynecology and Obstetrics, Prittwitzstr. 43, 89075, Ulm, Germany.
Jacobs University Bremen, Department of Psychology & Methods, Campus Ring 1, 28759, Bremen, Germany.
BMC Pregnancy Childbirth. 2023 Jan 23;23(1):55. doi: 10.1186/s12884-022-05304-8.
Progress in medicine involves the structured analysis and communication of errors. Comparability between the individual disciplines is only possible to a limited extent and obstetrics plays a special role: the expectation of a self-determined and joyful event meets with possibly serious complications in highly complex care situations. This must be managed by an interdisciplinary team with an increasingly condensed workload. Adverse events cannot be completely controlled. However, taking controllable risk factors into account and with a focused communication a reduction of preventable adverse events is possible. In the present study, the effect of interprofessional team training on preventable adverse events in an obstetric department was investigated.
The training consisted of a 4-h interdisciplinary training session based on psychological theories. Preventable adverse events were defined in six categories according to potential patterns of causation. 2,865 case records of a refence year (2018) and 2,846 case records of the year after the intervention (2020) were retrospectively evaluated. To determine the communication training effect, the identified preventable adverse events of 2018 and 2020 were compared according to categories and analyzed for obstetrically relevant controllable and uncontrollable risk factors. Questionnaires were used to identify improvements in self-reported perceptions and behaviors.
The results show that preventable adverse events in obstetrics were significantly reduced after the intervention compared to the reference year before the intervention (13.35% in the year 2018 vs. 8.83% in 2020, p < 0.005). Moreover, obstetrically controllable risk factors show a significant reduction in the year after the communication training. The questionnaires revealed an increase in perceived patient safety (t(28) = 4.09, p < .001), perceived communication behavior (t(30) = -2.95, p = .006), and self-efficacy to cope with difficult situations (t(28) = -2.64, p = .013).
This study shows that the communication training was able to reduce preventable adverse events and thus increase patient safety. In the future, regular trainings should be implemented alongside medical emergency trainings in obstetrics to improve patient safety. Additionally, this leads to the strengthening of human factors and ultimately also to the prevention of second victims. Further research should follow up implementing active control groups and a randomized-controlled trail study design.
The study was approved by the Ethics Committee of University Hospital (protocol code 114/19-FSt/Sta, date of approval 29 May 2019), study registration: NCT03855735 .
医学的进步涉及对错误的结构化分析和沟通。个体学科之间的可比性仅在有限程度上是可能的，而妇产科起着特殊的作用：对自主和快乐的事件的期望与高度复杂的护理情况下可能出现的严重并发症相遇。这必须由一个工作量日益紧张的跨学科团队来管理。不良事件是无法完全控制的。但是，考虑到可控的风险因素，并进行有针对性的沟通，可以减少可预防的不良事件。本研究旨在调查妇产科中跨专业团队培训对可预防不良事件的影响。
培训包括基于心理理论的 4 小时跨学科培训课程。根据潜在的因果模式，将可预防的不良事件定义为六个类别。回顾性评估了参考年（2018 年）的 2865 份病历记录和干预年后（2020 年）的 2846 份病历记录。为了确定沟通培训效果，根据类别比较 2018 年和 2020 年确定的可预防不良事件，并对产科相关可控和不可控风险因素进行分析。使用问卷来确定自我报告的感知和行为的改善。
结果表明，与干预前的参考年（2018 年为 13.35%，2020 年为 8.83%，p<0.005）相比，妇产科的可预防不良事件在干预后显著减少。此外，产科可控风险因素在沟通培训后显著减少。问卷调查显示，患者安全意识（t（28）=4.09，p<0.001）、沟通行为感知（t（30）=-2.95，p=0.006）和应对困难情况的自我效能感（t（28）=-2.64，p=0.013）均有所提高。
本研究表明，沟通培训能够减少可预防的不良事件，从而提高患者安全性。未来，应在妇产科中与医疗急救培训一起定期实施培训，以提高患者安全性。此外，这将加强人为因素，最终还将预防第二受害者。应进行进一步的研究，以实施积极的对照组和随机对照试验研究设计。
该研究得到了大学医院伦理委员会的批准（协议代码 114/19-FSt/Sta，批准日期 2019 年 5 月 29 日），研究注册：NCT03855735。
