The Impact of TeamSTEPPS Training on Obstetric Team Attitudes and Outcomes on the Labor and Delivery Unit of a Regional Perinatal Center.

Abstract

We investigated the effect of TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) training on teamwork perceptions and patient safety outcomes in an inpatient obstetrics setting. Physicians and nurses from the regional perinatal center were offered TeamSTEPPS instruction and administered a voluntary survey to assess subjective perceptions of team dynamics and patient safety prior to and 6 months following TeamSTEPPS training. Responses were analyzed using analysis of variance (ANOVA) and Chi-square test. Objective measures of patient safety outcomes were the incidence and blood loss of postpartum hemorrhage after vaginal delivery (PPH-VD) or cesarean section (PPH-CS) and incidence of shoulder dystocia (SD). Outcomes were analyzed using Mann-Whitney and Kruskal-Wallis tests. Surveys were collected from 20 physicians and 15 nurses prior to training and from 9 physicians and 20 nurses 6 months following training. Survey data showed an overall positive perception of teamwork and patient safety behaviors across all respondents. However, we found no significant changes in perception of team dynamics or behaviors to promote patient safety between pre- and posttraining time points. Physicians and nurses differed in perception of team dynamics (p = 0.001) and patient safety behaviors (p < 0.001), with nurses reporting more negative perception of safety behaviors posttraining. Physician attendees experienced a nonsignificant lower rate of PPH-VD and PPH-CS with unchanged blood loss, and an increased rate of SD compared with nonattendees in the 6 months following TeamSTEPPS training (p = 0.058, 0.20, and 0.21, respectively). Our experience with perinatal TeamSTEPPS training as a singular intervention was not demonstrative of improvement in teamwork and patient safety perceptions or incidences of obstetric emergencies suggesting that integration into a more comprehensive patient safety program and ongoing training of a larger proportion of providers per department may be necessary to realize tangible benefits of TeamSTEPPS. Our survey results also highlight important differences between physician and nursing staff perceptions. · There is value in a comprehensive patient safety program, such as TEAMSTEPPS, with ongoing training.. · Patient safety perceptions may differ between physician and nursing staff in the same unit.. · Health care staff must agree about the situation to improve patient safety..