Article Text

Download PDFPDF
Interventions for improving teamwork in intrapartum care: a systematic review of randomised controlled trials
  1. Michael Wu1,2,
  2. Jennifer Tang1,
  3. Nicole Etherington2,3,
  4. Mark Walker4,
  5. Sylvain Boet2,3
  1. 1 Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  2. 2 Department of Anesthesiology and Pain Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
  3. 3 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  4. 4 Department of Obstetrics, Gynecology, and Newborn Care, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  1. Correspondence to Dr Sylvain Boet, Anesthesiology and Pain Medicine, Ottawa Hospital, Ottawa, ON K1H 8L6, Canada; sboet{at}


Background The labour and delivery environment relies heavily on interdisciplinary collaboration from anaesthesiologists, obstetricians and nurses or midwives to deliver optimal patient care. A large number of adverse events in obstetrics are associated with failure in communication and teamwork among team members, with substantive consequences. The objective of this study is to perform a systematic review of interventions aimed at improving teamwork in obstetrics.

Methods This systematic review identified and assessed randomised controlled trials (RCTs) of interventions aimed at improving teamwork among interdisciplinary teams in obstetrical care. Medline, CENTRAL, CINAHL and Embase were searched for studies evaluating one of: patient outcomes, team performance or processes of clinical efficiency. Identified citations were reviewed in duplicate for eligibility.

Results Nine RCTs met the inclusion criteria; five of these RCTs were conducted under simulated clinical environments. Simulation-based teamwork training interventions were the most represented (n=7 studies, 3047 healthcare providers (HCPs), 107 782 births), followed by checklists (n=1 study, 136 HCPs) and an electronic-based decision support tool (n=1 study, 296 HCPs). Simulation-based teamwork training was found to improve team performance in 100% of relevant studies (3 of 3 studies assessing team performance) and patient morbidity in 75% of relevant studies (3 of 4 studies assessing patient morbidity). However, no direct mortality benefit was identified among all the studies reviewed. Studies were assessed to be of low-moderate quality and had significant limitations in their study designs.

Conclusion While the evidence is still limited and from low to moderate quality RCTs, simulation-based teamwork interventions appear to improve team performance and patient morbidity in labour and delivery care.

PROSPERO Trial registration number CRD42018090452

  • obstetrics and gynecology
  • communication
  • simulation
  • patient safety
  • team training

Statistics from


  • Twitter @Sylvainboet

  • Correction notice The article has been corrected since it was published online. The title of the article has been updated to ‘Interventions for improving teamwork in intrapartum care: a systematic review of randomised controlled trials’.

  • Funding This study was funded by The Ottawa Hospital Anesthesia Alternate Funds Association and Department of Anesthesiology, The Ottawa Hospital.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.