The importance of non‐technical performance for teams managing postpartum haemorrhage: video review of 99 obstetric teams

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.

Filming for auditing of real-life emergency teams: a systematic review

“…In an Australian survey, 96% of parents agreed to the use of video in neonatal resuscitation to improve patient safety 84. In a Danish study, patients and their relatives gave consent in 94% of the cases of major postpartum haemorrhage 85…”

Interprofessional teamwork for managing medical deterioration in pregnancy: what contributes to good clinical performance in simulated practice?

“…16 Two studies have conducted video analysis observations of teamwork in the management of emergencies in pregnancy. However, both have focused on emergencies directly related to the pregnancy (ie, postpartum haemorrhage 17 and pre-eclampsia 18 ) rather than medical deterioration due to pre-existing or new medical conditions (eg, asthma or epilepsy). Observational analysis of real-world incidents of postpartum haemorrhage suggest that effective leadership is a critical predictor of performance.…”

“…Observational analysis of real-world incidents of postpartum haemorrhage suggest that effective leadership is a critical predictor of performance. 17 Analysis of simulated scenarios involving pre-eclampsia suggest that teams that take time to coordinate and share the mental model of the problem and the actions required have better simulated outcomes. 18 These studies have analysed teamwork as a static phenomenon, assigning a total score for the whole team.…”

The OR Black Box Nursing Education Curriculum: Using Video Review to Optimize Patient Safety

“…Other disciplines have used audio and video recording to assess and evaluate quality improvement initiatives and to enhance teaching methods in the OR 5 . Similarly, this method has been used in other hospital departments; for example, to assess and review clinical and non‐technical performance during real‐life major postpartum hemorrhage 6 and during emergency room resuscitations 7 . Although health care providers have used audio and video recording in other disciplines and departments, to our knowledge, these methods have yet to be effectively utilized in continued education interventions for perioperative nurses.…”