Multidisciplinary training has improved maternity outcomes when the training has been well attended, regular, in house, used high-fidelity simulators, and integrated teamwork training. If these principles were used in other settings, better clinical care may result. This before-after study sought to establish whether a short multidisciplinary training intervention can improve recognition of the deteriorating patient using an aggregated physiological parameter scoring system (Early Warning Score [EWS]). Nursing, medical, and allied nursing staff participated in an hour-long training session, using real-life scenarios with simple tools and structured debriefing. After training, staff were more likely to calculate EWS scores correctly (68.02% vs 55.12%; risk ratio [RR] = 1.24, 95% confidence interval [CI] = 1.07-1.44), and observations were more likely to be performed at the correct frequency (78.57% vs 68.09%; RR = 1.20, 95% CI = 1.09-1.32). Multidisciplinary training, according to core principles, can lead to more accurate identification of deteriorating patients, with implications for subsequent care and outcome.
FindlayGPGoodwinAProtopapaKSmithNMasonM; National Confidential Enquiry into Patient Outcome and Death. Knowing the risk: a review of the peri-operative care of surgical patients. http://www.ncepod.org.uk/2011report2/downloads/POC_fullreport.pdf. Published December 2011. Accessed April 27, 2014.
4.
SwensenSPughMMcMullanCKabcenellA. High-Impact Leadership: Improve Care, Improve the Health of Populations and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; 2013:1-34.
5.
NealeGVincentCDarziSA. The problem of engaging hospital doctors in promoting safety and quality in clinical care. J R Soc Promot Health. 2007;127:87-94.
6.
Centre for Maternal and Child Enquiries. Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006-8. The eighth report on confidential enquiries into maternal deaths in the United Kingdom. BJOG. 2011;118(suppl 1):1-205.
7.
KneeboneRL. Practice, rehearsal, and performance: an approach for simulation-based surgical and procedure training. JAMA. 2009;302:1336-1338.
8.
McGaghieWCIssenbergSBCohenERBarsukJHWayneDB. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Acad Med. 2011;86:706-711.
9.
CookDAHatalaRBrydgesR. Technology-enhanced simulation for health professions education. JAMA. 2011;306:978-988.
10.
SiassakosDFoxRHuntL. Attitudes toward safety and teamwork in a maternity unit with embedded team training. Am J Med Qual. 2011;26:132-137.
11.
DraycottTSibandaTOwenL. Does training in obstetric emergencies improve neonatal outcome?BJOG. 2006;113:177-182.
12.
NeilyJMillsPDYoung-XuY. Association between implementation of a medical team training program and surgical mortality. JAMA. 2010;304:1693-1700.
13.
MacKenzieIZShahMLeanKDuttonSNewdickHTuckerDE. Management of shoulder dystocia: trends in incidence and maternal and neonatal morbidity. Obstet Gynecol. 2007;110:1059-1068.
14.
SiassakosDCroftsJFWinterCWeinerCPDraycottTJ. The active components of effective training in obstetric emergencies. BJOG. 2009;116:1028-1032.
15.
van der NelsonHASiassakosDBennettJ. Multiprofessional team simulation training, based on an obstetric model, can improve teamwork in other areas of healthcare. Am J Med Qual. 2014;29:78-82.
16.
National Patient Safety Agency. Recognising and Responding Appropriately to Early Signs of Deterioration in Hospitalised Patients. London, UK: National Patient Safety Agency; 2007.
17.
SemelMELipsitzSRFunkLMBaderAMWeiserTGGawandeAA. Rates and patterns of death after surgery in the United States, 1996 and 2006. Surgery. 2012;151:171-182.
SubbeCPKrugerMRutherfordPGemmelL. Validation of a modified early warning score in medical admissions. QJM. 2001;94:521-526.
21.
SubbeCPDaviesRGWilliamsERutherfordPGemmellL. Effect of introducing the modified early warning score on clinical outcomes, cardio-pulmonary arrests and intensive care utilisation in acute medical admissions. Anaesthesia. 2003;58:797-802.
22.
AlamNHobbelinkELvan TienhovenAJvan de VenPMJansmaEPNanayakkaraPWB. The impact of the use of the early warning score (EWS) on patient outcomes: a systematic review. Resuscitation. 2014;85:587-594.
23.
McNeillGBrydenD. Do either early warning systems or emergency response teams improve hospital patient survival? A systematic review. Resuscitation. 2013;84:1652-1667.
24.
McGaugheyJAlderdiceFFowlerRKapilaAMayhewAMoutrayM. Outreach and early warning systems (EWS) for the prevention of intensive care admission and death of critically ill adult patients on general hospital wards. Cochrane Database Syst Rev. 2007;(3):CD005529.
25.
SiassakosDDraycottT. Measuring the impact of simulation-based training on patient safety and quality of care: lessons from maternity. Resuscitation. 2011;82:782.
26.
SextonJBHelmreichRLNeilandsTB. The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Serv Res. 2006;6:44.
27.
EnglesbeMJPelletierSJMageeJC. Seasonal variation in surgical outcomes as measured by the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP). Ann Surg. 2007;246:456-465.
Royal College of Physicians. National Early Warning Score (NEWS): Standardising the Assessment of Acute-Illness Severity in the NHS. Report of a Working Party. London, UK: Royal College of Physicians. 2012:1-47.
30.
PrytherchDRSmithGBSchmidtP. Calculating early warning scores: a classroom comparison of pen and paper and hand-held computer methods. Resuscitation. 2006;70:173-178.
31.
ShoushtarianMBarnettMMcMahonFFerrisJ. Impact of introducing practical obstetric multi-professional rraining (PROMPT) into maternity units in Victoria, Australia. BJOG. 2014;121:1710-1718.
32.
SteinemannSBergBSkinnerA. In situ, multidisciplinary, simulation-based teamwork training improves early trauma care. J Surg Educ. 2011;68:472-477.
33.
TheilenULeonardPJonesP. Regular in situ simulation training of paediatric medical emergency team improves hospital response to deteriorating patients. Resuscitation. 2013;84:218-222.
34.
MoreyJCSimonRJayGD. Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. Health Serv Res. 2002;37:1553-1581.
35.
Armour ForseRBrambleJDMcQuillanR. Team training can improve operating room performance. Surgery. 2011;150:771-778.
36.
PaullDEMazziaLMWoodSD. Briefing guide study: preoperative briefing and postoperative debriefing checklists in the Veterans Health Administration medical team training program. Am J Surg. 2010;200:620-623.
37.
AwadSSFaganSPBellowsC. Bridging the communication gap in the operating room with medical team training. Am J Surg. 2005;190:770-774.
38.
CapellaJSmithSPhilpA. Teamwork training improves the clinical care of trauma patients. J Surg Educ. 2010;67:439-443.
39.
SiassakosDHasafaZSibandaT. Retrospective cohort study of diagnosis-delivery interval with umbilical cord prolapse: the effect of team training. BJOG. 2009;116:1089-1096.
40.
CroftsJFBartlettCEllisDHuntLPFoxRDraycottTJ. Management of shoulder dystocia: skill retention 6 and 12 months after training. Obstet Gynecol. 2007;110:1069-1074.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
