Effect of team training and monitoring on the rate of failed mid and low cavity vacuum extraction: a hospital based intervention study
Abstract Background Clinical team training has been advocated as a means to improve delivery care, and failed extractions is a suggested variable for clinical audit in instrumental vaginal delivery. Other activities may also have intended or unintended effects on care processes or outcomes. Methods...
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| Format: | Article |
| Language: | English |
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BMC
2019-03-01
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| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12884-019-2257-z |
| _version_ | 1818500732136980480 |
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| author | Kristina Pettersson Magnus Westgren Rebecca Götze-Eriksson Gunilla Ajne |
| author_facet | Kristina Pettersson Magnus Westgren Rebecca Götze-Eriksson Gunilla Ajne |
| author_sort | Kristina Pettersson |
| collection | DOAJ |
| description | Abstract Background Clinical team training has been advocated as a means to improve delivery care, and failed extractions is a suggested variable for clinical audit in instrumental vaginal delivery. Other activities may also have intended or unintended effects on care processes or outcomes. Methods We retrospectively observed 1074 mid and low vacuum extraction deliveries during three time periods (prevalence periods): Baseline (period 0), implemented team training (period 1 and 2) and monitoring of traction force during vacuum extraction (period 2). Our primary outcome was failed extraction followed by emergency cesarean section or obstetric forceps delivery. Results The prevalence proportion (relative risk) of failed extraction decreased significantly after implementation of team training, from 19% (period 0) to 8 % (period 1), corresponding to a relative risk of 0.48 [0.26–0.87]. The secondary procedural outcome complicated delivery (duration > 15 min or number of pulls > 6, or cup detachment > 1) was decreased in period 2 compared to period 1, RR 0.42 [0.23–0.76]. Secondary clinical (neonatal) outcome were not affected. Conclusion Clinically based educational efforts and increased monitoring improved procedural outcome without improving neonatal outcome. The study design has inherent limitations in making causal inference. |
| first_indexed | 2024-12-10T20:46:42Z |
| format | Article |
| id | doaj.art-f151354206524a61bdffccc5f755366f |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-12-10T20:46:42Z |
| publishDate | 2019-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-f151354206524a61bdffccc5f755366f2022-12-22T01:34:12ZengBMCBMC Pregnancy and Childbirth1471-23932019-03-011911710.1186/s12884-019-2257-zEffect of team training and monitoring on the rate of failed mid and low cavity vacuum extraction: a hospital based intervention studyKristina Pettersson0Magnus Westgren1Rebecca Götze-Eriksson2Gunilla Ajne3Department of Obstetrics and Gynecology, Karolinska University Hospital at HuddingeClintec, Karolinska InstituteDepartment of Obstetrics and Gynecology, Karolinska University Hospital at HuddingeDepartment of Obstetrics and Gynecology, Karolinska University Hospital at HuddingeAbstract Background Clinical team training has been advocated as a means to improve delivery care, and failed extractions is a suggested variable for clinical audit in instrumental vaginal delivery. Other activities may also have intended or unintended effects on care processes or outcomes. Methods We retrospectively observed 1074 mid and low vacuum extraction deliveries during three time periods (prevalence periods): Baseline (period 0), implemented team training (period 1 and 2) and monitoring of traction force during vacuum extraction (period 2). Our primary outcome was failed extraction followed by emergency cesarean section or obstetric forceps delivery. Results The prevalence proportion (relative risk) of failed extraction decreased significantly after implementation of team training, from 19% (period 0) to 8 % (period 1), corresponding to a relative risk of 0.48 [0.26–0.87]. The secondary procedural outcome complicated delivery (duration > 15 min or number of pulls > 6, or cup detachment > 1) was decreased in period 2 compared to period 1, RR 0.42 [0.23–0.76]. Secondary clinical (neonatal) outcome were not affected. Conclusion Clinically based educational efforts and increased monitoring improved procedural outcome without improving neonatal outcome. The study design has inherent limitations in making causal inference.http://link.springer.com/article/10.1186/s12884-019-2257-zVacuum extractionFailed extractionTeam trainingHawthorne effectMonitoring |
| spellingShingle | Kristina Pettersson Magnus Westgren Rebecca Götze-Eriksson Gunilla Ajne Effect of team training and monitoring on the rate of failed mid and low cavity vacuum extraction: a hospital based intervention study BMC Pregnancy and Childbirth Vacuum extraction Failed extraction Team training Hawthorne effect Monitoring |
| title | Effect of team training and monitoring on the rate of failed mid and low cavity vacuum extraction: a hospital based intervention study |
| title_full | Effect of team training and monitoring on the rate of failed mid and low cavity vacuum extraction: a hospital based intervention study |
| title_fullStr | Effect of team training and monitoring on the rate of failed mid and low cavity vacuum extraction: a hospital based intervention study |
| title_full_unstemmed | Effect of team training and monitoring on the rate of failed mid and low cavity vacuum extraction: a hospital based intervention study |
| title_short | Effect of team training and monitoring on the rate of failed mid and low cavity vacuum extraction: a hospital based intervention study |
| title_sort | effect of team training and monitoring on the rate of failed mid and low cavity vacuum extraction a hospital based intervention study |
| topic | Vacuum extraction Failed extraction Team training Hawthorne effect Monitoring |
| url | http://link.springer.com/article/10.1186/s12884-019-2257-z |
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