Summary of findings 1. Simulation‐based obstetric team training versus no training.
| Simulation‐based obstetric team training (SBOTT) versus no training | ||||||
| People: maternal and perinatal outcome and team performance in practice Setting: obstetric units of hospitals Intervention: Simulation‐based obstetric team training (SBOTT) Control: no training | ||||||
| Outcomes | Absolute effect* (95% CI) | Relative effect (95% CI) |
Number of participants and/or studies |
Certainty of the evidence (GRADE) | Comments | |
| Risk without training | Risk with simulation ‐based obstetric team training | |||||
| Maternal and perinatal outcome (Kirkpatrick level 4: patient outcome) |
See comments. | ‐ | 79,320 (3 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | Three studies reported different composite outcomes of maternal and/or perinatal adverse events. It was not clinically appropriate to pool these data. One study reported little to no difference for a composite outcome of maternal and perinatal adverse events (RR 1.00, 95% CI 0.78 to 1.27; 28,657 participants). Another study reported no clear difference between groups for maternal morbidity (RR 0.82, 95% CI 0.41 to 1.62; 50,589 women). A third study reported a mean Weighted Adverse Outcome Score of 0.72 (36 participants) after simulation‐based obstetric team training combined with didactics compared with 1.50 in the group that received no training (38 participants). |
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| Performance of obstetric team in practice (Kirkpatrick level 3: behavioural change) |
See comments. | ‐ | 2398 (3 RCTs) |
⊕⊕⊕⊝ MODERATE 2 | Data from 3 studies could not be pooled. SBOTT probably improves performance of the obstetric teams in practice in 2 studies. It probably improves overall team performance (MD in Clinical Teamwork Scale 1.00, 95% CI ‐0.02, 2.02; 1 study; 48 simulations), and increases a pro‐active treatment of post partum haemorrhage (RR 2.20, 95% CI 1.22 to 3.97; participants = 28,657) and prespecified obstetric procedures (RR 1.90, 95% CI 1.13 to 3.18; 48 simulations). In another study (641 births) it was unclear if SBOTT had any effect on routine birth practices (active management of third stage of labour, uterine sweeping, fundal pressure, skin to skin contact, delayed cord clamping, episiotomy). |
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| Maternal mortality (Kirkpatrick level 4: patient outcome) |
Study population | RR 0.82 (0.30, 2.27) | 79,246 (2 RCTs) |
⊕⊝⊝⊝ VERY LOW 1 3 | It is uncertain whether simulation‐based obstetric team training leads to change in maternal mortality. | |
| 6/39,381 women died in the SBOTT group compared with 7/39,865 women in the group without training | ||||||
| Neonatal mortality (Kirkpatrick level 4: patient outcome) |
Study population | RR 0.70 (0.48 to 1.01) | 79,246 (2 RCTs) | ⊕⊕⊝⊝ LOW 1 4 | ||
| 8 per 1000 | 6 per 1000 (4 tot 8) | |||||
| Low Apgar score (Kirkpatrick level 4: patient outcome) |
Study population | RR 0.99 (0.85 to 1.15) | 115,171 (2 RCTs) | ⊕⊕⊝⊝ LOW 1 4 | ||
| 14 per 1000 | 14 per 1000 (12 tot 17) | |||||
| Trauma due to shoulder dystocia (Kirkpatrick level 4: patient outcome) |
Study population | RR 0.50 (0.25 to 1.00) | 28,657 (1 RCT) | ⊕⊕⊕⊝ MODERATE 4 | ||
| 2 per 1000 | 1 per 1000 (1 tot 2) | |||||
| Cesarean delivery (Kirkpatrick level 4: patient outcome) |
Study population | RR 0.79 (0.67 to 0.93) | 50,589 (1 RCT) | ⊕⊕⊕⊝ MODERATE 1 | ||
| 368 per 1000 | 291 per 1000 (247 tot 342) | |||||
| The risk in the intervention group (and the 95% CI) is based on the risk in the control group and the relative effect of the intervention (and the 95% CI). CI: Confidence interval; MD: mean difference; RR: Risk ratio; | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | ||||||
1 Downgraded by one level because of serious risk of bias.
2 Downgraded by one level for inconsistency due to heterogeneity (studies not pooled)
3 Downgraded by two levels due to imprecision of data: wide 95% confidence interval spanning possible benefit and possible harm
4 Downgraded by one level due to imprecision of data: wide 95% confidence interval spanning possible benefit and possible harm