Effectiveness Evaluation Of Multidisciplinary Simulation Training In Obstetric Emergency

BackgroundObstetric emergencies refer to the sudden occurrence of acute diseases in the field of obstetrics,which seriously threaten the lives of pregnant and neonates,including postpartum hemorrhage,cardiac arrest,amniotic fluid embolism,umbilical cord prolapse,uterine rupture,acute uterine varus,anesthesia accidents,etc.They are the main factors leading to maternal death and adverse perinatal outcomes.Maternal and child health monitoring data show that the maternal mortality rate in China in 2017 is 19.6/100 000,which is 77.9% lower than that in 1990.However,compared with developed countries,the maternal mortality rate in China is still higher,among which obstetric hemorrhage,amniotic fluid embolism and pregnancy-induced hypertension are the top three.In the assessment and analysis of maternal mortality in various regions of China,the knowledge and skills of medical staff are the first of the avoidable factors.At present,most international guidelines related to obstetric emergencies recommend multidisciplinary team therapy and daily training exercises.Multidisciplinary simulation training of obstetric emergencies is to reproduce obstetric emergencies scene by various simulation means and train obstetricians,midwives and anesthesiologists.The purpose is to improve the level of emergency management and cooperation ability of obstetric teams and improve maternal and child outcomes.It covers all the standardized techniques of obstetric emergenciesmanagement.Although obstetric emergency training has been rapidly and widely used in the world,the training effects reported in the literature are not the same,and there is no public evidence of improvement in clinical outcomes in China.ObjectiveIn this study,a prospective cohort study was used to explore the teaching effect and the impact on obstetric quality after introducing multidisciplinary simulation training in obstetric emergency.?Material and Methods1.Subjects: 122 Multidisciplinary medical staff trained in obstetric emergencies at the Third Affiliated Hospital of Zhengzhou University from May 2017 to October 2017;and 29463 cases of women who were who give birth in this hospital from May 1,2016 to October 31,2018.?2.Research methods: From May 2017 to October 2017,a 2-day multidisciplinary simulation training of obstetric emergency was conducted for all obstetrics,and the Kirkpatrick's model was used to evaluate the teaching effect and the outcome of mother and infant.3.Statistical method: Data were processed by SPSS 21.0 software.3.Statistical method: Data were processed by SPSS 21.0 software.The measurement data is expressed by ±s.The comparison of the three groups of means was performed by one-way ANOVA.The data of non-normal distribution is expressed by the median(minimum,maximum).The Kruskal Wallis test was used when the samples were skewed distribution or non-variance homogeneity.The count data was described by frequency and rate,and the difference between 3 groups was compared by ?2 test or corrected ?2 test.The correlation between the variables was analyzed using Spearson correlation analysis.Differences were considered to be statistically significant at P<0.05.Results1.Satisfaction survey results: 80.32% of the trainees thought the course content was correct,77.87% were very satisfied with the instructor's teaching level,methods and methods,63.93% of the trainees thought that the simulation scene was well prepared,93.44% of the trainees thought that the course had extremely important clinical practicability,and it was necessary to carry out such courses.81.15% of the trainees thought that the course could be trained.Enough to harvest more new knowledge and skills.2.Achievements of theoretical exercises: The trainees' achievements in theory,practice,identification,judgment,help-seeking,operation,record and teamwork were significantly improved after training(P<0.05).Spearson correlation analysis was used to understand the relationship between participants' general situation and performance.The results showed that theoretical performance was positively correlated with study time(P<0.05),and participants' performance was positively correlated with age,title and working age(P<0.05).3.Obstetric outcomes: After the training,the total rate of cesarean delivery and the initial cesarean section rate were decreased(P<0.05).The average DDI of cesarean section was reduced from 20.58 min to 12.03 min,and the vaginal assist rate increased(P<0.05).There was no significant difference in the rate of temporary brachial plexus injury in neonates with a 1-min Apgar score?7,a 5-min Apgar score?7,and a neonatal severe asphyxia rate(P<0.05).The incidence of shoulder dystocia and perineal cut rate increased(P<0.05),and there was no temporary brachial plexus injury caused by shoulder dystocia.There was no significant change in the rate of changed to cesarean section cesarean section,immediate cesarean section rate and postpartum hemorrhage(P<0.05).ConclusionMultidisciplinary simulation training for obstetric emergency can significantly improve the knowledge and skills of multidisciplinary medical staff,enhance teamwork,and improve maternal and child outcomes in the short term after training.The Kirkpatrick's model effectively evaluates the quality of training and identifies problems.