Cathy Winter

A randomised controlled trial of care of the perineum during second stage of normal labour

Objective To compare the effect of two methods of perineal management used during spontaneous vaginal delivery on the prevalence of perineal pain reported at 10 days after birth.

Retrospective cohort study of diagnosis–delivery interval with umbilical cord prolapse: the effect of team training

Objective  To determine whether the introduction of multi‐professional simulation training was associated with improvements in the management of cord prolapse, in particular, the diagnosis–delivery interval (DDI).

The active components of effective training in obstetric emergencies

Confidential enquiries into poor perinatal outcomes have identified deficiencies in team working as a common factor and have recommended team training in the management of obstetric emergencies. Isolated aviation‐based team training programmes have not been associated with improved perinatal outcomes when applied to labour ward settings, whereas obstetric‐specific training interventions with integrated teamwork have been associated with clinical improvements. This commentary reviews obstetric emergency training programmes from hospitals that have demonstrated improved outcomes to determine the active components of effective training. The common features identified were: institution‐level incentives to train; multi‐professional training of all staff in their units; teamwork training integrated with clinical teaching and use of high fidelity simulation models. Local training also appeared to facilitate self‐directed infrastructural change.

Clinical efficiency in a simulated emergency and relationship to team behaviours: a multisite cross‐sectional study

Please cite this paper as: Siassakos D, Bristowe K, Draycott T, Angouri J, Hambly H, Winter C, Crofts J, Hunt L, Fox R. Clinical efficiency in a simulated emergency and relationship to team behaviours: a multisite cross‐sectional study. BJOG 2011;118:596–607.

More to teamwork than knowledge, skill and attitude

Please cite this paper as: Siassakos D, Draycott T, Crofts J, Hunt L, Winter C, Fox R. More to teamwork than knowledge, skill and attitude. BJOG 2010;117:1262–1269.

Attitudes Toward Safety and Teamwork in a Maternity Unit With Embedded Team Training

The objective of this study was to identify any residual challenges in a unit with a track record of good clinical performance. A cross-sectional survey of frontline caregiver attitudes was conducted using a validated psychometric instrument. A total of 69% (91 of 132) of eligible participants completed questionnaires. The results indicated positive safety culture, teamwork climate, and job satisfaction. Perceptions of high workload and insufficient staffing levels were the most prominent negative observations but not to the detriment of job satisfaction or perception of work conditions. Male staff had consistently better safety attitudes in multivariate analyses. The authors identified 24-hour consultant (attending) presence and better support by management as prerequisites for further improvement. Teamwork and safety attitudes are positive in a unit with established interprofessional team training. Establishing better support by senior clinical and management leaders was identified as a necessary intervention to improve attitudes and safety.

Quality improvement demands quality measurement

Please cite this paper as: Draycott T, Sibanda T, Laxton C, Winter C, Mahmood T, Fox R. Quality improvement demands quality measurement. BJOG 2010;117:1571–1574.

Myths and realities of training in obstetric emergencies

Training for intrapartum emergencies is a promising strategy to reduce preventable harm during birth; however, not all training is clinically effective. Many myths have developed around such training. These principally derive from misinformed beliefs that all training must be effective, cheap, independent of context and sustainable. The current evidence base for effective training supports local, unit-based and multi-professional training, with appropriate mannequins, and practice-based tools to support the best care. Training programmes based on these principles are associated with improved clinical outcomes, but we need to understand how and why that is, and also why some training is associated with no improvements, or even deterioration in outcomes. Effective training is not cheap, but it can be cost-effective. Insurers have the fiscal power to incentivise training, but they should demand the evidence of clinical effect; aspiration and proxies alone should no longer be sufficient for funding, in any resource setting.

Multiprofessional ‘fire‐drill’ training in the labour ward

•  Regular multiprofessional rehearsals of the management of obstetric emergencies have been recommended since 1997. •  In‐house training is cheap and associated with improved outcomes. •  Teamwork failure is associated with poor obstetric outcome but aviation‐based team training is not a panacea: we may need to develop and evaluate obstetric‐specific interventions.

The cost of local, multi-professional obstetric emergencies training.

We aim to outline the annual cost of setting up and running a standard, local, multi‐professional obstetric emergencies training course, PROMPT (PRactical Obstetric Multi‐Professional Training), at Southmead Hospital, Bristol, UK – a unit caring for approximately 6500 births per year.