Lessons From a Randomized Control Trial: Impact of Checklists on Teamwork During Simulated Obstetric Emergencies [26A]

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Abstract

INTRODUCTION:

Emergency checklists have been offered as an important tool to improve patient outcomes. This study aims to determine whether use of an initial version of ACOG District II Safe Motherhood Initiative checklists during simulated obstetric emergencies improves interdisciplinary teamwork.

METHODS:

During this randomized-control trial, interprofessional teams undergoing simulation-based training for Eclampsia and Postpartum Hemorrhage (PPH) were randomly assigned to utilize a standardized checklist during one of two simulated emergencies. Teams without checklists served as controls. Trained raters reviewed all videos of simulated obstetric emergencies and used the “Clinical Teamwork Scale” (CTS) to assess various facets of teamwork. This scale assesses 6 items: overall team work, communication, situational awareness, decision making, role responsibilities, and patient friendly language use among team members. Teams with checklists were compared to those without checklists using Mann-Whitney U test.

RESULTS:

36 teams (148 multidisciplinary providers) completed 72 scenarios. Data is presented for teams with complete video available for review, 29 teams randomized to the checklist group (14 Eclampsia and 15 PPH) and 30 randomized to the no checklist group (15 Eclampsia and 15 PPH). When comparing checklist group to no checklist group for each of the 6 CTS items, regardless of scenario, there were no statistically significant differences noted between the two groups.

CONCLUSION:

While checklists hold promise to improve team performance, before introducing them it is critical to test them. We believe optimal focus on checklist design, piloting use with modifications based on feedback, intensive implementation planning and training will result in improved patient outcomes and team work.

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