Effect of a cluster randomised team training intervention on adverse perinatal and maternal outcomes: a stepped wedge study.

OBJECTIVE: To study the effect of an intervention based on Crew Resource Management team training, including the SBARR tool for structured communication, on adverse perinatal and maternal outcomes.

DESIGN: Stepped wedge.

SETTING: the Netherlands.

POPULATION OR SAMPLE: Registry data of 8 123 women referred from primary-care to a hospital during childbirth, at ≥32.0 weeks of singleton gestation and with no congenital abnormalities, in the period 2012 to 2015.

METHODS: Obstetrical teams of five hospitals and their surrounding primary-care midwifery practices participated in the intervention. In total 49 team training sessions were organised for 465 care professionals (75,5% participated). Adverse perinatal and maternal outcomes before, during and after the intervention were analysed using multivariate logistic regression analyses.

MAIN OUTCOME MEASURES: Adverse Outcome Index (AOI - 5), a composite measure involving; intrapartum or neonatal death, admission to neonatal intensive care unit, APGAR <7 at 5 minutes, postpartum haemorrhage and/or perineal tear.

RESULTS: In total, an AOI-5 score was reported in 11.3% of the study population. No significant difference was found in the incidence of the AOI-5 score after the intervention compared to before the intervention (OR: 1.07: 95%CI 0.92 - 1.24)..

CONCLUSIONS: We found no effect of the intervention on adverse perinatal and maternal outcomes for women who were referred during childbirth. Team training is appreciated in practice, but evidence on the long-term impact is still limited. Upcoming studies should build on previous research and consider more sensitive outcome measures. This article is protected by copyright. All rights reserved.