Board #165 - Research Abstract Transmural Multi-professional Simulation-based Obstetric Team Training and Its Effect on Quality of Care as Perceived by Women Who Recently Gave Birth (Submission #9135)

Abstract

Hypothesis Several studies have shown that many adverse events in obstetrics can be explained by ineffective teamwork and communication. Recent data has shown that women who had been referred to the hospital reported lower quality of care.1 In the Netherlands, obstetric care is organized in primary care (represented by independent midwives providing care to women with low-risk pregnancies) and secondary care (responsible for high-risk pregnancies). About 65% of all pregnant women are referred from the primary to secondary care during pregnancy or labour,2 resulting in multiple medical handovers. Besides medical outcome, patient-reported outcomes are becoming more important as indicators of care quality.3 If communication and collaboration between and within different care levels improves, the perceived quality of care will increase. We hypothesized transmural multi-professional simulation-based obstetric team training to improve quality of care as perceived by women who gave birth. Methods An experimental study with simulation-based obstetric team training in the area of a hospital in the Netherlands. In five groups, 75 care providers were trained in a medical simulation center. The transmural teams represented the obstetric collaborative network consisting of: ambulance personnel, maternity nurses, community midwives, obstetric nurses, hospital midwives, residents, and obstetricians. The one-day training focused on non-technical skills like teamwork and communication using SBAR communication and crew resource management (CRM). To measure quality of care as perceived by women, the Pregnancy & Childbirth Questionnaire (PCQ) 1 was assessed at six weeks postpartum, before the training (sample I, N=76) and three months after the training (sample II, N=68). The 25-item PCQ consists of three subscales: personal treatment during pregnancy, educational information, and personal treatment during delivery, with higher scores indicating better perceived quality of care. Results At baseline, a PCQ mean total score of 103.5 [11.6] (M[SD]) was measured at six weeks postpartum (N=76). Three months after the team training intervention, a higher PCQ total score of 108.9 [10.9] was reported (N=68), indicating a significant increase in perceived quality of care (t=2.75, p=0.007). The effect size of the increase in PCQ total score was medium (Cohen’s d=0.5). Moreover, the subscales ‘personal treatment during pregnancy’ and ‘educational information’ showed a significant increase after the team training (p<0.01), while the subscale ‘personal treatment during delivery’ did not. The items with the largest significant increase in mean scores included: communication between care providers, clear leadership, involvement in planning, and better provision of information. Conclusion Transmural multi-professional simulation-based obstetric team training improves quality of care as perceived by women who recently gave birth.