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The importance of non‐technical performance for teams managing postpartum haemorrhage: video review of 99 obstetric teams
Author(s) -
Brogaard L,
Kierkegaard O,
Hvidman L,
Jensen KR,
Musaeus P,
Uldbjerg N,
Manser T
Publication year - 2019
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.15655
Subject(s) - postpartum haemorrhage , obstetrics , medicine , operations management , computer science , pregnancy , engineering , genetics , biology
Objective Little is known about how teams’ non‐technical performance influences clinical performance in obstetric emergencies such as postpartum haemorrhage. Design Video review – observational study. Setting A university hospital (5000 deliveries) and a regional hospital (2000 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 ( AOTP ); outcomes were the clinical performance score (Team OBS ) 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 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. Conclusion 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. Tweetable abstract Non‐technical performance is important for teams managing postpartum haemorrhage; video review of 99 obstetric teams.