Effect on treatment
Postpartum haemorrhaging in the mother can be lethal. Especially in parts of the world without good-quality transfusion services, this can be a significant cause of maternal mortality (10). A study undertaken in Stavanger compared the need for blood transfusions in cases of severe haemorrhaging prior to and after the personnel had participated in a six-hour interdisciplinary and scenario-based team training session in the handling of such situations (11, 12). More than 1 000 deliveries were included in the study. The proportion of postpartum women who received blood transfusions after an estimated blood loss of 500 ml was nearly halved – from 21 % to 12 % (12). The group found a similar decrease in the number of transfusions in a study undertaken in Tanzania (11), where a similar, brief simulation-based intervention had been conducted.
We need to focus more on the people working within these systems and on how we relate to each other and to risk, rather than have blind faith in technical systems
A doctoral thesis from the University of Southern Denmark investigated outcomes for severely injured patients at the Odense trauma centre. Since 2004, this hospital has held regular training sessions for its trauma teams. The study showed that the likelihood of patient survival was significantly higher when the team members were experienced and/or had participated in interdisciplinary team training (13). Experience is accumulated over time, but team training may compensate for less experience among team members. These findings tally with equivalent studies from the USA (14).
Stroke is one of the main causes of morbidity and mortality globally. Rapid thrombolytic and/or endovascular treatment is crucial to achieve the best possible patient outcome. Stavanger University Hospital has succeeded in reducing the average door-to-needle time from 30 minutes to 13 minutes, with a subsequent reduction in 90-day morbidity and mortality (15). In all likelihood, this is due to interdisciplinary quality improvement efforts, a key feature of which has been regular team simulations in the emergency room.
A study from a Dutch intensive-care unit described the effect of team training in the department over a period of three years, before and after the team training of the entire staff. After the training, the incidence of cardiac arrest fell to a third of the pre-training level. In the same period, the survival rate increased from 19 % to 55 % (16). The number of adverse events also declined significantly. Similarly, an American study has shown that younger doctors who had undergone simulation-based training in advanced cardiopulmonary resuscitation provide better treatment to patients with cardiac arrest (17).