No abstract

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 (TeamOBS) 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.

We have examined the relationship between perioperative headache and various factors in 219 patients who fasted from midnight and underwent minor surgery under general anaesthesia. Four to six hours after operation all patients completed a questionnaire on previous frequency of headache, daily consumption of caffeine and occurrence of perioperative headache. The duration of fasting, type of surgery, premedication and anaesthetic agents used were obtained from the anaesthetic record. After multivariate logistic regression analysis a significant risk of preoperative headache was found in patients who normally experienced headache more than twice a month (odds ratio (OR): 7.7; confidence interval (CI): 2.9-20.1), had a daily caffeine consumption > 400 mg/24 h (OR: 5.0; CI: 1.6-14.8) and who were anaesthetized after 12:00 (OR: 3.7; CI: 1.4-9.8). The risk of postoperative headache was significantly greater in patients with preoperative headache (OR: 16.9; CI: 6.5-43.8), daily caffeine consumption > 400 mg/24 h (OR: 3.9; CI: 1.5-9.6) and in those patients who received atracurium, which was similar to the risk of tracheal intubation.

The TeamOBS-PPH tool appears to be valid and reliable for assessing clinical performance in real-life and simulated settings. The tool will be shared as the free TeamOBS App.

Introduction We aimed to investigate whether noise in delivery rooms is associated with impaired performance of obstetric teams managing major (≥1000 mL) postpartum hemorrhage. Material and methods We included video recordings of 96 obstetric teams managing real-life major postpartum hemorrhage. Exposure was noise defined as the occurrence of sound level pressures (SPL) above 90 dB. The outcome was high clinical performance assessed through expert ratings using the TeamOBS-PPH tool. Results The 23 teams unexposed to noise had a significantly higher chance of high clinical performance than the 73 teams exposed to noise: 91.3% (95% CI; 72.0–98.9) versus 58.9% (95% CI; 46.8–70.3) ( p < 0.001). The results remained significant when adjusting for the following possible confounders: team size, non-technical performance, bleeding velocity, hospital type, etiology of bleeding, event duration and time of day. Typical sources of noise above 90 dB SPL were mother or baby crying, dropping of instruments, and slamming of cupboard doors. Conclusion Noise in delivery rooms may be an independent source of impaired clinical performance.