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- Title
The importance of non-technical performance for teams managing postpartum haemorrhage: video review of 99 obstetric teams.
- Authors
Brogaard, L; Kierkegaard, O; Hvidman, L; Jensen, KR; Musaeus, P; Uldbjerg, N; Manser, T; Jensen, K R
- Abstract
<bold>Objective: </bold>Little is known about how teams' non-technical performance influences clinical performance in obstetric emergencies such as postpartum haemorrhage.<bold>Design: </bold>Video review - observational study.<bold>Setting: </bold>A university hospital (5000 deliveries) and a regional hospital (2000 deliveries) in Denmark.<bold>Population: </bold>Obstetric teams managing real-life postpartum haemorrhage.<bold>Methods: </bold>We systematically assessed 99 video recordings of obstetric teams managing real-life major postpartum haemorrhage. Exposure was the non-technical score (AOTP); 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).<bold>Results: </bold>Teams with an excellent non-technical score performed significantly better than teams with a poor non-technical score: 83.7 versus 0.3% chance of a high clinical performance score (P < 0.001), 0.2 versus 80% risk of a low clinical performance score (P < 0.001), and 3.5 versus 31.7% risk of delayed transfer to the operating theatre (P = 0.008). The results remained robust when adjusting for potential confounders such as 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 behavior, and leadership. Communication with the patient and closing the loop were of minor importance. All performance assessments showed good reliability: 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.<bold>Conclusion: </bold>Video review offers a new method and new perspectives for research in obstetric teams to identify how teams become effective and safe; the skills identified in this study can be included in future obstetric training programmes.<bold>Tweetable Abstract: </bold>Non-technical performance is important for teams managing postpartum haemorrhage; video review of 99 obstetric teams.
- Publication
BJOG: An International Journal of Obstetrics & Gynaecology, 2019, Vol 126, Issue 8, p1015
- ISSN
1470-0328
- Publication type
journal article
- DOI
10.1111/1471-0528.15655