Simulation‐based team training for multi‐professional obstetric care teams to improve patient outcome: a multicentre, cluster randomised controlled trial

摘要

Objective To investigate whether simulation‐based obstetric team training in a simulation centre improves patient outcome. Design Multicentre, open, cluster randomised controlled trial. Setting Obstetric units in the Netherlands. Population Women with a singleton pregnancy beyond 24 weeks of gestation. Methods Random allocation of obstetric units to a 1‐day, multi‐professional, simulation‐based team training focusing on crew resource management ( CRM ) in a simulation centre or to no such team training. Intention‐to‐treat analyses were performed at the cluster level, including a measurement 1 year prior to the intervention. Main outcome measures Primary outcome was a composite outcome of obstetric complications during the first year post‐intervention, including low Apgar score, severe postpartum haemorrhage, trauma due to shoulder dystocia, eclampsia and hypoxic‐ischaemic encephalopathy. Maternal and perinatal mortality were also registered. Results Each study group included 12 units with a median unit size of 1224 women, combining for a total of 28 657 women. In total, 471 medical professionals received the training course. The composite outcome of obstetric complications did not differ between study groups [odds ratio ( OR ) 1.0, 95% confidence interval ( CI ) 0.80–1.3]. Team training reduced trauma due to shoulder dystocia ( OR 0.50, 95% CI 0.25–0.99) and increased invasive treatment for severe postpartum haemorrhage ( OR 2.2, 95% CI 1.2–3.9) compared with no intervention. Other outcomes did not differ between study groups. Conclusion A 1‐day, off‐site, simulation‐based team training, focusing on teamwork skills, did not reduce a composite of obstetric complications. Tweetable abstract 1‐day, off‐site, simulation‐based team training did not reduce a composite of obstetric complications.