The importance of non-technical performance for teams managing postpartum haemorrhage: video review of 99 obstetric teams

Abstract

Objective: Little is known about how teams' non-technical performance influences clinical performance in obstetric emergencies such as postpartum haemorrhage.

Design: Video review - observational study.

Setting: A university hospital (5000 deliveries) and a regional hospital (2000 deliveries) in Denmark.

Population: Obstetric teams managing real-life postpartum haemorrhage.

Methods: We systematically assessed 99 video recordings of obstetric teams managing real-life major postpartum haemorrhage. Exposure was the non-technical score (AOTP); outcomes were the clinical performance score (TeamOBS) and the delayed transfer to the operating theatre (defined as blood loss >1500 ml in the delivery room).

Results: Teams with an excellent non-technical score performed significantly better than teams with a poor non-technical score: 83.7 versus 0.3% chance of a high clinical performance score (P < 0.001), 0.2 versus 80% risk of a low clinical performance score (P < 0.001), and 3.5 versus 31.7% risk of delayed transfer to the operating theatre (P = 0.008). The results remained robust when adjusting for potential confounders such as bleeding velocity, aetiology, time of day, team size, and hospital. The specific non-technical skills associated with high clinical performance were vigilance, role assignment, problem-solving, management of disruptive behavior, and leadership. Communication with the patient and closing the loop were of minor importance. All performance assessments showed good reliability: the intraclass correlation was 0.97 (95% CI 0.96-0.98) for the non-technical score and 0.84 (95% CI 0.76-0.89) for the clinical performance score.

Conclusion: Video review offers a new method and new perspectives for research in obstetric teams to identify how teams become effective and safe; the skills identified in this study can be included in future obstetric training programmes.

Tweetable abstract: Non-technical performance is important for teams managing postpartum haemorrhage; video review of 99 obstetric teams.

Keywords: Clinical performance; emergency treatment; non-technical skills; obstetric labour complications; postpartum haemorrhage; teamwork; video analysis.