Effects of Teamwork Training on Adverse Outcomes and Process of Care in Labor and Delivery

作者：Peter E. Nielsen, MARLENE B. GOLDMAN, Susan Mann, David E. Shapiro, Ronald G. Marcus, Stephen D. Pratt, Penny Greenberg, Patricia L. McNamee, Mary L. Salisbury, David J. Birnbach, Paul Gluck, Mark D. Pearlman, Heidi B. King, David N. Tornberg, Benjamin P. Sachs · 发表于：Obstetrics and Gynecology · 年份：2007 · DOI：10.1097/01.aog.0000250900.53126.c2 · 被引用次数：326 · 研究领域：Maternal and Perinatal Health Interventions、Patient Safety and Medication Errors、Simulation-Based Education in Healthcare

OBJECTIVE: To evaluate the effect of teamwork training on the occurrence of adverse outcomes and process of care in labor and delivery. METHODS: A cluster-randomized controlled trial was conducted at seven intervention and eight control hospitals. The intervention was a standardized teamwork training curriculum based on crew resource management that emphasized communication and team structure. The primary outcome was the proportion of deliveries at 20 weeks or more of gestation in which one or more adverse maternal or neonatal outcomes or both occurred (Adverse Outcome Index). Additional outcomes included 11 clinical process measures. RESULTS: A total of 1,307 personnel were trained and 28,536 deliveries analyzed. At baseline, there were no differences in demographic or delivery characteristics between the groups. The mean Adverse Outcome Index prevalence was similar in the control and intervention groups, both at baseline and after implementation of teamwork training (9.4% versus 9.0% and 7.2% versus 8.3%, respectively). The intracluster correlation coefficient was 0.015, with a resultant wide confidence interval for the difference in mean Adverse Outcome Index between groups (-5.6% to 3.2%). One process measure, the time from the decision to perform an immediate cesarean delivery to the incision, differed significantly after team training (33.3 minutes versus 21.2 minutes, P=.03). CONCLUSION: Training, as was conducted and implemented, did not transfer to a detectable impac...