Reports from the Institute of Medicine propose that team training—and implementing team behaviors—can cut down on medical errors and enhance patient safety. The present investigators tested this idea in the area of obstetrics, a discipline that calls for intensive and error-free vigilance as well as effective communication between numerous disciplines. A cluster-randomized controlled trial was undertaken at 15 US hospitals: at seven a standardized teamwork training curriculum was introduced that focused on free communication and team structure. The remaining eight hospitals made up a control group. The curriculum (MedTeams Labor and Delivery Team Coordination Course) was based on care resource management, which attempts to utilize the ability of each team member to analyze and react to situations in ways that lessen the potential for error. A total of 1307 individuals were trained, and 28,536 deliveries were analyzed. Negative outcomes were quantified using an index outcome measure, the Adverse Outcome Index.
The intervention and control groups were similar demographically and obstetrically at the outset. Adverse outcome indices also were comparable, and remained so after teamwork training was implemented. The only process measure that differed significantly after team training was in the interval from deciding to perform an immediate cesarean delivery to making the incision, which decreased from 33 to 21 minutes. There was considerable variability across hospitals in the commonest maternal outcome, a third- or fourth-degree perineal laceration following vaginal delivery, and also in the most prevalent neonatal outcome, unplanned admission to the neonatal intensive care unit. Postimplementation outcome measures did not differ significantly even after controlling for baseline differences.
This study failed to show that teamwork training in obstetrical practices had any important clinical impact. Nevertheless, the Adverse Outcome Index might prove helpful when comparing obstetrical outcomes within and between institutions.
Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, Washington; Departments of Obstetrics and Gynecology and Anesthesia, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Biostatistics, Harvard School of Public Health, Boston Massachusetts; Miller School of Medicine, University of Miami, Miami, Florida; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor; and TRICARE Management Activity, Falls Church, Virginia
Obstet Gynecol 2007;109:48–55