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The importance of non-technical performance for teams managing postpartum haemorrhage: video review of 99 obstetric teams.
BJOG : An International Journal of Obstetrics and Gynaecology 2019 Februrary 17
OBJECTIVE: Little is known about how teams' non-technical performance influences clinical performance in obstetric emergencies like postpartum haemorrhage.
DESIGN: Video review - observational study.
SETTING: A university hospital (5,000 deliveries) and a regional hospital (2,000 deliveries) in Denmark.
POPULATION: Obstetric teams managing real-life postpartum haemorrhage.
METHODS: We systematically assessed 99 video recordings of obstetric teams managing real-life major postpartum haemorrhage. Exposure was the non-technical score (ATOP); outcomes were the clinical performance score (TeamOBS) and the delayed transfer to the operating theatre (defined as blood loss >1500 mL in the delivery room).
RESULTS: Teams with an excellent non-technical score performed significantly better than teams with a poor non-technical score: 83.7% vs. 0.3% chance of a high clinical performance score (p <0.001), 0.2% vs. 80% risk of a low clinical performance score (p <0.001) and 3.5% vs. 31.7% risk of delayed transfer to the operating theatre (p=0.008). The results remained robust when adjusting for potential confounders like bleeding velocity, aetiology, time of day, team size and hospital. The specific non-technical skills associated with high clinical performance were vigilance, role assignment, problem solving, management of disruptive behaviour and leadership. Communication with the patient and closing the loop were of minor importance. All performance assessments showed good reliability as the intraclass correlation was 0.97 (95%CI; 0.96-0.98) for the non-technical score and 0.84 (95%CI; 0.76-0.89) for the clinical performance score.
CONCLUSION: Video review offers a new method and new perspectives of research in obstetric teams to identify how teams become effective and safe, and the skills identified in this study can be included in future obstetric training programmes. This article is protected by copyright. All rights reserved.
DESIGN: Video review - observational study.
SETTING: A university hospital (5,000 deliveries) and a regional hospital (2,000 deliveries) in Denmark.
POPULATION: Obstetric teams managing real-life postpartum haemorrhage.
METHODS: We systematically assessed 99 video recordings of obstetric teams managing real-life major postpartum haemorrhage. Exposure was the non-technical score (ATOP); outcomes were the clinical performance score (TeamOBS) and the delayed transfer to the operating theatre (defined as blood loss >1500 mL in the delivery room).
RESULTS: Teams with an excellent non-technical score performed significantly better than teams with a poor non-technical score: 83.7% vs. 0.3% chance of a high clinical performance score (p <0.001), 0.2% vs. 80% risk of a low clinical performance score (p <0.001) and 3.5% vs. 31.7% risk of delayed transfer to the operating theatre (p=0.008). The results remained robust when adjusting for potential confounders like bleeding velocity, aetiology, time of day, team size and hospital. The specific non-technical skills associated with high clinical performance were vigilance, role assignment, problem solving, management of disruptive behaviour and leadership. Communication with the patient and closing the loop were of minor importance. All performance assessments showed good reliability as the intraclass correlation was 0.97 (95%CI; 0.96-0.98) for the non-technical score and 0.84 (95%CI; 0.76-0.89) for the clinical performance score.
CONCLUSION: Video review offers a new method and new perspectives of research in obstetric teams to identify how teams become effective and safe, and the skills identified in this study can be included in future obstetric training programmes. This article is protected by copyright. All rights reserved.
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