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"title": "Multidisciplinary team training in a simulation setting for acute obstetric emergencies: a systematic review",
"creators": [
{
"creatorType": "author",
"firstName": "A E R",
"lastName": "Merién"
},
{
"creatorType": "author",
"firstName": "J",
"lastName": "van de Ven"
},
{
"creatorType": "author",
"firstName": "B W",
"lastName": "Mol"
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{
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"firstName": "S",
"lastName": "Houterman"
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"firstName": "S G",
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"abstractNote": "OBJECTIVE To perform a systematic review of the literature on the effectiveness of multidisciplinary teamwork training in a simulation setting for the reduction of medical adverse outcomes in obstetric emergency situations. DATA SOURCES We searched Medline, Embase, and the Cochrane Library from inception to June 2009. The search strategy contained medical subject heading terms (\"patient care team\" and \"patient simulation\" and \"obstetrics\" or \"gynecology\" and \"education\" or \"teaching\") and additional text words (\"teamwork,\" \"simulation,\" \"training\"). METHODS OF STUDY SELECTION Studies describing and evaluating teamwork training programs with simulation models for labor ward staff in acute obstetric emergencies were selected. The search revealed 97 articles. TABULATION, INTEGRATION, AND RESULTS All studies were assessed independently by two reviewers for methodological quality using the quality assessment of diagnostic accuracy studies (QUADAS) criteria. Only eight articles assessed the effect of teamwork training in a simulation setting. Four of them were randomized controlled trials and four were cohort studies. The only study that reported on perinatal outcome showed an improvement in terms of 5-minute Apgar score and hypoxic-ischemic encephalopathy. The seven other studies showed that teamwork training in a simulation setting resulted in improvement of knowledge, practical skills, communication, and team performance in acute obstetric situations. Training in a simulation center did not further improve outcome compared with training in a local hospital. CONCLUSION Introduction of multidisciplinary teamwork training with integrated acute obstetric training interventions in a simulation setting is potentially effective in the prevention of errors, thus improving patient safety in acute obstetric emergencies. Studies on its effectiveness and cost-effectiveness are needed before team training can be implemented on broad scale.",
"publicationTitle": "Obstetrics and Gynecology",
"volume": "115",
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"pages": "1021-1031",
"date": "May 2010",
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"journalAbbreviation": "Obstet Gynecol",
"language": "",
"DOI": "10.1097/AOG.0b013e3181d9f4cd",
"ISSN": "1873-233X",
"shortTitle": "Multidisciplinary team training in a simulation setting for acute obstetric emergencies",
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{
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{
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{
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{
"tag": "Pregnancy Outcome",
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"title": "Mobile in situ obstetric emergency simulation and teamwork training to improve maternal-fetal safety in hospitals",
"creators": [
{
"creatorType": "author",
"firstName": "Jeanne-Marie",
"lastName": "Guise"
},
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"creatorType": "author",
"firstName": "Nancy K",
"lastName": "Lowe"
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"firstName": "Patricia O",
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{
"creatorType": "author",
"firstName": "Christen",
"lastName": "O'Haire"
},
{
"creatorType": "author",
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"firstName": "Molly",
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"abstractNote": "BACKGROUND: Evidence from other high-risk industries has demonstrated that teamwork skills can be taught and effective teamwork may improve safety. Increasingly, health care providers, hospital administrators, and quality and safety professionals are considering simulation as a strategy to improve quality and patient safety. MOBILE OBSTETRIC SIMULATION AND TEAM TRAINING PROGRAM: A mobile obstetric emergency simulation and team training program was created to bring simulation technology and teamwork training used routinely in other high reliability fields directly to health care institutions. A mobile unit constituted a practical approach, given the expense of simulation equipment, the time required for staff to develop educational materials and simulation scenarios, and the need to have a standardized program to promote consistent evaluation across sites. Between 2007 and 2009, in situ simulation of obstetric emergencies and teamwork training was tested with more than 150 health care professionals in labor and delivery units across four rural and two community hospitals in Oregon. HOW DO ORGANIZATIONS DETERMINE WHICH TYPE OF SIMULATION IS BEST FOR THEM? Because simulation technologies are relatively costly to start and maintain, it can be challenging for hospitals and health care professionals to determine which format (send staff to a simulation center, develop in-house simulation program, develop a consortium of hospitals that run a simulation program, or use a mobile simulation program) is best for them. CONCLUSIONS: In situ simulation is an effective way to develop new skills, to maintain infrequently used clinical skills even among experienced clinical teams, and to uncover and address latent safety threats in the clinical setting.",
"publicationTitle": "Joint Commission Journal on Quality and Patient Safety / Joint Commission Resources",
"volume": "36",
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"abstractNote": "It has been estimated that full implementation of the Affordable Care Act will extend coverage to thirty-two million previously uninsured Americans. However, rapidly rising health care costs could thwart that effort. Since 1988 Intermountain Healthcare has applied to health care delivery the insights of W. Edwards Deming’s process management theory, which says that the best way to reduce costs is to improve quality. Intermountain achieved such quality-based savings through measuring, understanding, and managing variation among clinicians in providing care. Intermountain created data systems and management structures that increased accountability, drove improvement, and produced savings. For example, a new delivery protocol helped reduce rates of elective induced labor, unplanned cesarean sections, and admissions to newborn intensive care units. That one protocol saves an estimated $50 million in Utah each year. If applied nationally, it would save about $3.5 billion. “Organized care” along these lines may be central to the long-term success of health reform.",
"publicationTitle": "Health Affairs",
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"abstractNote": "Since 2007, performance data from California hospitals have been publicly available on a Web site under the direction of a multi-stakeholder collaborative, the California Hospital Assessment and Reporting Taskforce (CHART). To help CHART leaders evaluate the usefulness of its work to consumers, the Center for Healthcare Decisions studied consumer perceptions of four Institute of Medicine quality domains: clinical effectiveness, patient safety, responsiveness to patients, and efficiency. The qualitative research involved a series of discussions with diverse groups of consumers throughout California.\n\nThe research described in this report is intended to help hospitals set priorities for corrective action and to provide new insights for those involved in public reporting. Among the prominent findings is that consumers attach little importance to the patient safety domain until they are given examples of how failures in this domain could impact patients. After discussions about patient safety, consumers tended to assign this domain the highest priority.",
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"title": "Decision support and patient safety: the time has come",
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"firstName": "Steve K",
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"abstractNote": "Decision support (DS) may help to improve patient safety by helping clinicians improve the evaluation, assessment, and treatment of patients. By providing best practice guidelines at critical decision points, errors can be prevented. Location of these decision points varies in different care environments, therefore DS must be customizable. Being able to customize the design, functionality, and clinical context of how a DS rule behaves may help each unique clinical environment improve performance. The ability to review aggregate data on the behavior of both the DS system and the providers will be necessary to further adapt the DS rule to the setting. A robust tool set and ongoing institutional engagement are critical elements for a successful DS implementation.",
"publicationTitle": "American Journal of Obstetrics and Gynecology",
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"date": "Dec 6, 2010",
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"journalAbbreviation": "Am J Obstet Gynecol",
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"shortTitle": "Decision support and patient safety",
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"itemType": "journalArticle",
"title": "Pregnancy outcomes in a recurrent preterm birth prevention clinic",
"creators": [
{
"creatorType": "author",
"firstName": "Tracy A",
"lastName": "Manuck"
},
{
"creatorType": "author",
"firstName": "Erick",
"lastName": "Henry"
},
{
"creatorType": "author",
"firstName": "Jonathan",
"lastName": "Gibson"
},
{
"creatorType": "author",
"firstName": "Michael W",
"lastName": "Varner"
},
{
"creatorType": "author",
"firstName": "T Flint",
"lastName": "Porter"
},
{
"creatorType": "author",
"firstName": "G Marc",
"lastName": "Jackson"
},
{
"creatorType": "author",
"firstName": "M Sean",
"lastName": "Esplin"
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],
"abstractNote": "OBJECTIVE We sought to compare rates of recurrent spontaneous preterm birth (PTB) and neonatal morbidity between women enrolled in a recurrent PTB prevention clinic compared to those receiving usual care. STUDY DESIGN This was a retrospective cohort study of women with a single, nonanomalous fetus and ≥1 spontaneous PTB <35 weeks. Women enrolled in a recurrent PTB prevention clinic were compared to those receiving usual care. The recurrent PTB prevention clinic was consultative and included 3 standardized visits. Usual-care patients were treated by their primary provider. The primary outcome was recurrent spontaneous PTB <37 weeks. RESULTS Seventy recurrent PTB prevention clinic and 153 usual-care patients were included. Both groups had similar pregnancy histories. Recurrent PTB prevention clinic patients had increased utilization of resources, had lower rates of recurrent spontaneous PTB (48.6% vs 63.4%, P = .04), delivered later (mean 36.1 vs 34.9 weeks, P = .02), and had lower rates of composite major neonatal morbidity (5.7% vs 16.3%, P = .03). CONCLUSION Women referred to a consultative recurrent PTB prevention clinic had reduced rates of recurrent spontaneous prematurity and major neonatal morbidity.",
"publicationTitle": "American Journal of Obstetrics and Gynecology",
"volume": "204",
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"abstractNote": "OBJECTIVE We sought to determine whether implementation of shoulder dystocia training reduces the incidence of obstetric brachial plexus injury (OBPI). STUDY DESIGN After implementing training for maternity staff, the incidence of OBPI was compared between pretraining and posttraining periods using both univariate and multivariate analyses in deliveries complicated by shoulder dystocia. RESULTS The overall incidence of OBPI in vaginal deliveries decreased from 0.40% pretraining to 0.14% posttraining (P < .01). OBPI after shoulder dystocia dropped from 30% to 10.67% posttraining (P < .01). Maternal body mass index (P < .01) and neonatal weight (P = .02) decreased and head-to-body delivery interval increased in the posttraining period (P = .03). Only shoulder dystocia training remained associated with reduced OBPI (P = .02) after logistic regression analysis. OBPI remained less in the posttraining period (P = .01), even after excluding all neonates with birthweights >2 SD above the mean. CONCLUSION Shoulder dystocia training was associated with a lower incidence of OBPI and the incidence of OBPI in births complicated by shoulder dystocia.",
"publicationTitle": "American Journal of Obstetrics and Gynecology",
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"abstractNote": "BACKGROUND:: Severe preamputation pain is associated with phantom limb pain (PLP) development in limb amputees. We investigated whether optimized perioperative analgesia reduces PLP at 6-month follow-up. METHODS:: A total of 65 patients underwent lower-limb amputation and were assigned to five analgesic regimens: (1) Epi/Epi/Epi patients received perioperative epidural analgesia and epidural anesthesia; (2) PCA/Epi/Epi patients received preoperative intravenous patient-controlled analgesia (PCA), postoperative epidural analgesia, and epidural anesthesia; (3) PCA/Epi/PCA patients received perioperative intravenous PCA and epidural anesthesia; (4) PCA/GA/PCA patients received perioperative intravenous PCA and general anesthesia (GA); (5) controls received conventional analgesia and GA. Epidural analgesia or intravenous PCA started 48 h preoperatively and continued 48 h postoperatively. The results of the visual analog scale and the McGill Pain Questionnaire were recorded perioperatively and at 1 and 6 months. RESULTS:: At 6 months, median (minimum-maximum) PLP and P values (intervention groups vs. control group) for the visual analog scale were as follows: 0 (0-20) for Epi/Epi/Epi (P = 0.001), 0 (0-42) for PCA/Epi/Epi (P = 0.014), 20 (0-40) for PCA/Epi/PCA (P = 0.532), 0 (0-30) for PCA/GA/PCA (P = 0.008), and 20 (0-58) for controls. The values for the McGill Pain Questionnaire were as follows: 0 (0-7) for Epi/Epi/Epi (P < 0.001), 0 (0-9) for PCA/Epi/Epi (P = 0.003), 6 (0-11) for PCA/Epi/PCA (P = 0.208), 0 (0-9) for PCA/GA/PCA (P = 0.003), and 7 (0-15) for controls. At 6 months, PLP was present in 1 of 13 Epi/Epi/Epi, 4 of 13 PCA/Epi/Epi, and 3 of 13 PCA/GA/PCA patients versus 9 of 12 control patients (P = 0.001, P = 0.027, and P = 0.009, respectively). Residual limb pain at 6 months was insignificant. CONCLUSIONS:: Optimized epidural analgesia or intravenous PCA, starting 48 h preoperatively and continuing for 48 h postoperatively, decreases PLP at 6 months.",
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}
],
"abstractNote": "The purpose of this study was to survey members of the Central Association of Obstetricians and Gynecologists about professional liability claims.\nA survey was mailed to Central Association of Obstetricians and Gynecologists members regarding medical liability experience.\nOf the 897 surveys mailed, 73% were completed. The responding 658 clinicians had been in practice for 17,136 years and had 1507 closed claims. The respondents had a claim every 11 years of practice and a trial every 69 years. Matched for years of practice, a case control comparison indicated that the litigation is significantly lower for female physicians (1.5 +/- 1.8) than for male physicians (2.2 +/- 2.0; P = .019) although the mean cases that were dropped or dismissed were higher for men (1.3 +/- 1.7 vs 0.8 +/- 1.4; P = .022). However, the mean number of trials, defense trial verdicts, and the settlement amounts were similar for both genders.\nWe found that professional liability claims are uncommon and that the gender of the obstetrician-gynecologist influences the litigation profile.",
"publicationTitle": "American Journal of Obstetrics and Gynecology",
"volume": "192",
"issue": "6",
"pages": "1820-1826; discussion 1826-1828",
"date": "Jun 2005",
"series": "",
"seriesTitle": "",
"seriesText": "",
"journalAbbreviation": "Am. J. Obstet. Gynecol",
"language": "",
"DOI": "10.1016/j.ajog.2004.12.058",
"ISSN": "0002-9378",
"shortTitle": "Professional liability claims and Central Association of Obstetricians and Gynecologists members",
"url": "http://www.ncbi.nlm.nih.gov/pubmed/15970818",
"accessDate": "2011-03-03T05:45:27Z",
"archive": "",
"archiveLocation": "",
"libraryCatalog": "NCBI PubMed",
"callNumber": "",
"rights": "",
"extra": "PMID: 15970818",
"tags": [
{
"tag": "Adult",
"type": 1
},
{
"tag": "Aged",
"type": 1
},
{
"tag": "Case-Control Studies",
"type": 1
},
{
"tag": "Compensation and Redress",
"type": 1
},
{
"tag": "Female",
"type": 1
},
{
"tag": "Gynecology",
"type": 1
},
{
"tag": "Humans",
"type": 1
},
{
"tag": "Insurance, Liability",
"type": 1
},
{
"tag": "Liability, Legal",
"type": 1
},
{
"tag": "Male",
"type": 1
},
{
"tag": "Malpractice",
"type": 1
},
{
"tag": "Middle Aged",
"type": 1
},
{
"tag": "Obstetrics",
"type": 1
},
{
"tag": "Pregnancy",
"type": 1
},
{
"tag": "Questionnaires",
"type": 1
},
{
"tag": "Societies, Medical",
"type": 1
},
{
"tag": "United States",
"type": 1
},
{
"tag": "liability"
}
],
"collections": [],
"relations": {},
"dateAdded": "2011-03-03T05:45:27Z",
"dateModified": "2011-03-03T05:45:27Z"
}
}
]