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Obstetrics & Gynecology 2008;111:723-731
© 2008 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Hospital, Simulation Center, and Teamwork Training for Eclampsia Management

A Randomized Controlled Trial

Denise Ellis, RM1, Joanna F. Crofts, BMBS1, Linda P. Hunt, PhD2, Mike Read, MD3, Robert Fox, MB4 and Mark James, MD3

From the 1Department of Obstetrics and Gynaecology, North Bristol NHS Trust, Southmead Hospital, Bristol; 2University Department of Clinical Sciences at South Bristol, Institute of Child Life and Health, UBHT Education Centre, Bristol; 3Department of Obstetrics and Gynaecology, Gloucestershire Hospitals NHS Trust, Gloucester; and 4Department of Obstetrics and Gynaecology, Taunton and Somerset NHS Trust, Musgrove Park Hospital, Taunton, United Kingdom.

OBJECTIVE: To compare the effectiveness of training for eclampsia in local hospitals and a regional simulation center, with and without teamwork theory.

METHODS: This study is a randomized controlled trial of training in local hospitals and in a simulation center in the United Kingdom. Midwives and obstetricians working at participating hospitals were randomly assigned to 24 teams. Teams were randomly allocated to training in local hospitals or at a simulation center, and to teamwork theory or not. Performance was evaluated before and after training with a standardized eclampsia scenario captured on video. Outcome measures were completion of tasks, time to completion of tasks, administration of magnesium sulfate, and quality of teamwork.

RESULTS: Training was associated with an increase in completion of basic tasks; 87% before training and 100% afterward. Basic tasks were completed more quickly; 55 seconds compared with 27 seconds, P=.012. The magnesium sulfate loading dose was administered by 61% of teams before training and by 92% afterward (P=.040). There was a shorter median time to administration (116 seconds less; P=.011). Training at the simulation center was not associated with additional improvement. Teamwork generally improved (median global score rose from 2.5 to 4.0; P<.001) but there was no additional benefit from teamwork training.

CONCLUSION: Training resulted in enhanced performance with higher rates of completion for basic tasks, shorter times to administration of magnesium sulfate, and improved teamwork. There was no additional benefit from training in a simulation center, and none from teamwork theory.

CLINICAL TRIAL REGISTRATION: ISRCTN, http://isrctn.org, ISRCTN67906788, reference number 0270030

LEVEL OF EVIDENCE: I






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