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ORIGINAL RESEARCH |
From the 1Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, Washington; the Departments of 2Obstetrics and Gynecology and 3Anesthesia, Beth Israel Deaconess Medical Center, Boston, Massachusetts; the 4Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts; 5Miller School of Medicine, University of Miami, Miami, Florida; the 6Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; 7TRICARE Management Activity, Falls Church, Virginia.
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 impact in this study. The Adverse Outcome Index could be an important tool for comparing obstetric outcomes within and between institutions to help guide quality improvement.
CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00381056
LEVEL OF EVIDENCE: I
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