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Obstetrics: Patient safety series
Interdisciplinary team training identifies discrepancies in institutional policies and practices

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The objective of this study was to evaluate the impact of an interdisciplinary team-training program in obstetric emergencies on identifying unsupportive institutional policies and systems-based practices. We implemented a qualitative study design with a purposive sample of interdisciplinary physicians, nurses, and ancillary allied health professionals from 4 specialties (n = 79) to conduct a 6-month, weekly simulation-based intervention for managing obstetric emergencies. Debriefing focused on identifying discrepancies between clinical practice and institutional policies. Our data yielded 5 categories of discrepancies between institutional or departmental policy and actual clinical practice. Specific institutional policies and system-based practices were recommended to health system administration for reevaluation. Simulation-based interdisciplinary team training can inform system-wide quality improvement objectives that could lead to increased patient safety.

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Materials and methods

We hypothesized that simulation-based interdisciplinary training would reveal system-level and specialty-specific procedural and policy conflicts with the potential to adversely impact patient care. We designed the OBEMAN (Obstetrics, Emergency Medicine, Anesthesiology, and Neonatology) Program as an intervention targeting interdisciplinary teams of physicians, nurses, and ancillary health professionals tasked with managing obstetric emergencies at the University of Michigan. The program

Results

Transcripts from the debriefing sessions identified 5 main types of system-level and specialty-specific practices, policies, and procedures that could potentially cause conflict within the clinical team or adversely impact patient care. We named these categories and illustrate each type with an example below: (1) policies certatim, (2) policies impossibilia, (3) policies casualis, (4) policies oblivio, and (5) policies absens. The frequency with which an occurrence from each category arose

Comments

The results of this study demonstrate that simulation-based interdisciplinary team training can serve to identify systems-based policy discrepancies that remain undiscovered because of the relative infrequency with which they are required. We identified 5 types of incongruent policies governing clinical practice in the management of obstetric emergencies, each of which was in evidence during every training session and often at multiple occurrences within the session. Our results provide

Acknowledgments

We thank the Department of Obstetrics and Gynecology Center for Education at the University of Michigan. Mr Randall Richter, Mr Woojin Shim, and the staff at the University of Michigan Clinical Simulation Center (UMCSC).

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This project was funded by a GME Innovations Grant from the University of Michigan Medical School Office of Graduate Medical Education.

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