Effect of a cluster randomised team training intervention on adverse perinatal and maternal outcomes: a stepped wedge study

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Abstract

Objective: To study the effect of an intervention based on Crew Resource Management team training, including a tool for structured communication, on adverse perinatal and maternal outcomes. Design: Stepped wedge. Setting: The Netherlands. Population or sample: Registry data of 8123 women referred from primary care to a hospital during childbirth, at ≥ 32.0 weeks of singleton gestation and with no congenital abnormalities, in the period 2012–15. Methods: Obstetric teams of five hospitals and their surrounding primary-care midwifery practices participated in the intervention. In total, 49 team training sessions were organised for 465 care professionals (75.5% participated). Adverse perinatal and maternal outcomes before, during and after the intervention were analysed using multivariate logistic regression analyses. Main Outcome Measures: Adverse Outcome Index (AOI-5), a composite measure involving; intrapartum or neonatal death, admission to neonatal intensive care unit, Apgar < 7 at 5 minutes, postpartum haemorrhage and/or perineal tear. Results: In total, an AOI-5 score was reported in 11.3% of the study population. No significant difference was found in the incidence of the AOI-5 score after the intervention compared with before the intervention (OR 1.07: 95% CI 0.92–1.24). Conclusions: We found no effect of the intervention on adverse perinatal and maternal outcomes for women who were referred during childbirth. Team training is appreciated in practice, but evidence on the long-term impact is still limited. Upcoming studies should build on previous research and consider more sensitive outcome measures. Tweetable abstract: A cluster randomised team training intervention showed no effect on adverse perinatal and maternal outcomes for women referred during childbirth.
Original languageEnglish
Pages (from-to)907-914
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume126
Issue number7
DOIs
Publication statusPublished - 2019

Cite this

@article{1a9c8e54bd83440eaf5af02103d830e4,
title = "Effect of a cluster randomised team training intervention on adverse perinatal and maternal outcomes: a stepped wedge study",
abstract = "Objective: To study the effect of an intervention based on Crew Resource Management team training, including a tool for structured communication, on adverse perinatal and maternal outcomes. Design: Stepped wedge. Setting: The Netherlands. Population or sample: Registry data of 8123 women referred from primary care to a hospital during childbirth, at ≥ 32.0 weeks of singleton gestation and with no congenital abnormalities, in the period 2012–15. Methods: Obstetric teams of five hospitals and their surrounding primary-care midwifery practices participated in the intervention. In total, 49 team training sessions were organised for 465 care professionals (75.5{\%} participated). Adverse perinatal and maternal outcomes before, during and after the intervention were analysed using multivariate logistic regression analyses. Main Outcome Measures: Adverse Outcome Index (AOI-5), a composite measure involving; intrapartum or neonatal death, admission to neonatal intensive care unit, Apgar < 7 at 5 minutes, postpartum haemorrhage and/or perineal tear. Results: In total, an AOI-5 score was reported in 11.3{\%} of the study population. No significant difference was found in the incidence of the AOI-5 score after the intervention compared with before the intervention (OR 1.07: 95{\%} CI 0.92–1.24). Conclusions: We found no effect of the intervention on adverse perinatal and maternal outcomes for women who were referred during childbirth. Team training is appreciated in practice, but evidence on the long-term impact is still limited. Upcoming studies should build on previous research and consider more sensitive outcome measures. Tweetable abstract: A cluster randomised team training intervention showed no effect on adverse perinatal and maternal outcomes for women referred during childbirth.",
author = "A. Romijn and Ravelli, {A. C. J.} and {de Bruijne}, {M. C.} and Twisk, {J. W. R.} and C. Wagner and {de Groot}, {C. J. M.} and Teunissen, {P. W.}",
year = "2019",
doi = "10.1111/1471-0528.15611",
language = "English",
volume = "126",
pages = "907--914",
journal = "BJOG: An International Journal of Obstetrics & Gynaecology",
issn = "1470-0328",
publisher = "Wiley Online Library",
number = "7",

}

TY - JOUR

T1 - Effect of a cluster randomised team training intervention on adverse perinatal and maternal outcomes: a stepped wedge study

AU - Romijn, A.

AU - Ravelli, A. C. J.

AU - de Bruijne, M. C.

AU - Twisk, J. W. R.

AU - Wagner, C.

AU - de Groot, C. J. M.

AU - Teunissen, P. W.

PY - 2019

Y1 - 2019

N2 - Objective: To study the effect of an intervention based on Crew Resource Management team training, including a tool for structured communication, on adverse perinatal and maternal outcomes. Design: Stepped wedge. Setting: The Netherlands. Population or sample: Registry data of 8123 women referred from primary care to a hospital during childbirth, at ≥ 32.0 weeks of singleton gestation and with no congenital abnormalities, in the period 2012–15. Methods: Obstetric teams of five hospitals and their surrounding primary-care midwifery practices participated in the intervention. In total, 49 team training sessions were organised for 465 care professionals (75.5% participated). Adverse perinatal and maternal outcomes before, during and after the intervention were analysed using multivariate logistic regression analyses. Main Outcome Measures: Adverse Outcome Index (AOI-5), a composite measure involving; intrapartum or neonatal death, admission to neonatal intensive care unit, Apgar < 7 at 5 minutes, postpartum haemorrhage and/or perineal tear. Results: In total, an AOI-5 score was reported in 11.3% of the study population. No significant difference was found in the incidence of the AOI-5 score after the intervention compared with before the intervention (OR 1.07: 95% CI 0.92–1.24). Conclusions: We found no effect of the intervention on adverse perinatal and maternal outcomes for women who were referred during childbirth. Team training is appreciated in practice, but evidence on the long-term impact is still limited. Upcoming studies should build on previous research and consider more sensitive outcome measures. Tweetable abstract: A cluster randomised team training intervention showed no effect on adverse perinatal and maternal outcomes for women referred during childbirth.

AB - Objective: To study the effect of an intervention based on Crew Resource Management team training, including a tool for structured communication, on adverse perinatal and maternal outcomes. Design: Stepped wedge. Setting: The Netherlands. Population or sample: Registry data of 8123 women referred from primary care to a hospital during childbirth, at ≥ 32.0 weeks of singleton gestation and with no congenital abnormalities, in the period 2012–15. Methods: Obstetric teams of five hospitals and their surrounding primary-care midwifery practices participated in the intervention. In total, 49 team training sessions were organised for 465 care professionals (75.5% participated). Adverse perinatal and maternal outcomes before, during and after the intervention were analysed using multivariate logistic regression analyses. Main Outcome Measures: Adverse Outcome Index (AOI-5), a composite measure involving; intrapartum or neonatal death, admission to neonatal intensive care unit, Apgar < 7 at 5 minutes, postpartum haemorrhage and/or perineal tear. Results: In total, an AOI-5 score was reported in 11.3% of the study population. No significant difference was found in the incidence of the AOI-5 score after the intervention compared with before the intervention (OR 1.07: 95% CI 0.92–1.24). Conclusions: We found no effect of the intervention on adverse perinatal and maternal outcomes for women who were referred during childbirth. Team training is appreciated in practice, but evidence on the long-term impact is still limited. Upcoming studies should build on previous research and consider more sensitive outcome measures. Tweetable abstract: A cluster randomised team training intervention showed no effect on adverse perinatal and maternal outcomes for women referred during childbirth.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/30633417

U2 - 10.1111/1471-0528.15611

DO - 10.1111/1471-0528.15611

M3 - Article

VL - 126

SP - 907

EP - 914

JO - BJOG: An International Journal of Obstetrics & Gynaecology

JF - BJOG: An International Journal of Obstetrics & Gynaecology

SN - 1470-0328

IS - 7

ER -