Impact of multi-professional, scenario-based training on postpartum hemorrhage in Tanzania: a quasi-experimental, pre- vs. post-intervention study

Autor: Pål Øian, Lars Edvin Bru, Torbjørn Moe Eggebø, Cecilia Mushi, Signe Egenberg, Gileard Masenga, Deodatus Amadeus Massay
Rok vydání: 2017
Předmět:
Male
Blood transfusion
Non-Randomized Controlled Trials as Topic
medicine.medical_treatment
fødselskomplikasjoner
Logistic regression
Tanzania
0302 clinical medicine
Obstetrics and gynaecology
Pregnancy
030212 general & internal medicine
030219 obstetrics & reproductive medicine
biology
Debriefing
Obstetrics and Gynecology
Teamwork
Perinatal Care
postpartum hemorrhage
Female
Medical emergency
Research Article
Adult
medicine.medical_specialty
Scenario-based training
Interprofessional Relations
education
Reproductive medicine
blood transfusion
lcsh:Gynecology and obstetrics
03 medical and health sciences
medicine
Humans
multi-professional
lcsh:RG1-991
Patient Care Team
business.industry
Problem-Based Learning
Delivery
Obstetric
biology.organism_classification
medicine.disease
VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Gynekologi og obstetrikk: 756
Postpartum hemorrhage
Standardized mortality ratio
Emergency medicine
Multi-professional
blodoverføring
Medical disciplines: 700::Clinical medical disciplines: 750::Gynecology and obstetrics: 756 [VDP]
business
Zdroj: BMC Pregnancy and Childbirth, Vol 17, Iss 1, Pp 1-11 (2017)
BMC Pregnancy and Childbirth
ISSN: 1471-2393
DOI: 10.1186/s12884-017-1478-2
Popis: Source at: https://doi.org/10.1186/s12884-017-1478-2 Background: Tanzania has a relatively high maternal mortality ratio of 410 per 100,000 live births. Severe postpartum hemorrhage (PPH) is a major cause of maternal deaths, but in most cases, it is preventable. However, most pregnant women that develop PPH, have no known risk factors. Therefore, preventive measures must be offered to all pregnant women. This study investigated the effects of multi-professional, scenario-based training on the prevention and management of PPH at a Tanzanian zonal consultant hospital. We hypothesized that scenario-based training could contribute to improved competence on PPH-management, which would result in improved team efficiency and patient outcome. Methods: This quasi-experimental, pre-vs. post-interventional study involved on-site multi-professional, scenario-based PPH training, conducted in a two-week period in October 2013 and another 2 weeks in November 2014. Training teams included nurses, midwives, doctors, and medical attendants in the Department of Obstetrics and Gynecology. After technical skill training on the birthing simulator MamaNatalie®, the teams practiced in realistic scenarios on PPH. Each scenario was followed by debriefing and repeated scenario. Afterwards, the group swapped roles and the observers became the participants. To evaluate the effects of training, we measured patient outcomes by determining blood transfusion rates. Patient data were collected by randomly sampling Medical birth registry files from the pre-training and post-training study periods (n = 1667 and 1641 files, respectively). Data were analyzed with the Chi-square test, Mann-Whitney U-test, and binary logistic regression. Results: The random patient samples (n = 3308) showed that, compared to pre-training, post-training patients had a 47% drop in whole blood transfusion rates and significant increases in cesarean section rates, birth weights, and vacuum deliveries. The logistic regression analysis showed that transfusion rates were significantly associated with the time period (pre- vs. post-training), cesarean section, patients tranferred from other hospitals, maternal age, and female genital mutilation and cutting. Conclusions: We found that multi-professional, scenario-based training was associated with a significant, 47% reduction in whole blood transfusion rates. These results suggested that training that included all levels of maternity staff, repeated sessions with realistic scenarios, and debriefing may have contributed to reduced blood transfusion rates in this high-risk maternity setting.
Databáze: OpenAIRE
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