Effect of hands-on interprofessional simulation training for local emergencies in Scotland: the THISTLE stepped-wedge design randomised controlled trial

Erik Lenguerrand (Corresponding Author), Cathy Winter, Dimitrios Siassakos, Graeme MacLennan, Karen Innes, Pauline Lynch, Alan Cameron, Joanna Crofts, Alison McDonald, Kirsty McCormack, Mark Forrest, John Norrie, Siladitya Bhattacharya, Tim Draycott

Research output: Contribution to journalArticle

Abstract

Objective To assess whether the implementation of an intrapartum training package (PROMPT (PRactical Obstetric Multi-Professional Training)) across a health service reduced the proportion of term babies born with Apgar score <7 at 5 min (<75mins). 
Design Stepped-wedge cluster randomised controlled trial. 
Setting Twelve randomised maternity units with ≥900 births/year in Scotland. Three additional units were included in a supplementary analysis to assess the effect across Scotland. The intervention commenced in March 2014 with follow-up until September 2016. 
Intervention The PROMPT training package (Second edition), with subsequent unit-level implementation of PROMPT courses for all maternity staff. 
Main outcome measures The primary outcome was the proportion of term babies with Apgar<75mins. 
Results 87 204 eligible births (99.2% with an Apgar score), of which 1291 infants had an Apgar<75mins were delivered in the 12 randomised maternity units. Two units did not implement the intervention. The overall Apgar<75mins rate observed in the 12 randomised units was 1.49%, increasing from 1.32% preintervention to 1.59% postintervention. Once adjusted for a secular time trend, the ‘intention-to-treat’ analysis indicated a moderate but non-significant reduction in the rate of term babies with an Apgar scores <75mins following PROMPT training (OR=0.79 95%CI(0.63 to 1.01)). However, some units implemented the intervention earlier than their allocated step, whereas others delayed the intervention. The content and authenticity of the implemented intervention varied widely at unit level. When the actual date of implementation of the intervention in each unit was considered in the analysis, there was no evidence of improvement (OR=1.01 (0.84 to 1.22)). No intervention effect was detected by broadening the analysis to include all 15 large Scottish maternity units. Units with a history of higher rates of Apgar<75mins maintained higher Apgar rates during the study (OR=2.09 (1.28 to 3.41)) compared with units with pre-study rates aligned to the national rate. 
Conclusions PROMPT training, as implemented, had no effect on the rate of Apgar <75mins in Scotland during the study period. Local implementation at scale was found to be more difficult than anticipated. Further research is required to understand why the positive effects observed in other single-unit studies have not been replicated in Scottish maternity units, and how units can be best supported to locally implement the intervention authentically and effectively. 
Trial registration number ISRCTN11640515.
Original languageEnglish
Number of pages13
JournalBMJ Quality & Safety
Early online date13 Jul 2019
DOIs
Publication statusE-pub ahead of print - 13 Jul 2019

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Apgar Score
Scotland
Emergencies
Randomized Controlled Trials
Parturition
Intention to Treat Analysis
Obstetrics
Health Services
Outcome Assessment (Health Care)
Research
Simulation Training

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Effect of hands-on interprofessional simulation training for local emergencies in Scotland : the THISTLE stepped-wedge design randomised controlled trial. / Lenguerrand, Erik (Corresponding Author); Winter, Cathy; Siassakos, Dimitrios; MacLennan, Graeme; Innes, Karen; Lynch, Pauline; Cameron, Alan; Crofts, Joanna; McDonald, Alison; McCormack, Kirsty; Forrest, Mark; Norrie, John; Bhattacharya, Siladitya; Draycott, Tim.

In: BMJ Quality & Safety, 13.07.2019.

Research output: Contribution to journalArticle

Lenguerrand, Erik ; Winter, Cathy ; Siassakos, Dimitrios ; MacLennan, Graeme ; Innes, Karen ; Lynch, Pauline ; Cameron, Alan ; Crofts, Joanna ; McDonald, Alison ; McCormack, Kirsty ; Forrest, Mark ; Norrie, John ; Bhattacharya, Siladitya ; Draycott, Tim. / Effect of hands-on interprofessional simulation training for local emergencies in Scotland : the THISTLE stepped-wedge design randomised controlled trial. In: BMJ Quality & Safety. 2019.
@article{81d085dc1f0747a4b91d7b5516b36261,
title = "Effect of hands-on interprofessional simulation training for local emergencies in Scotland: the THISTLE stepped-wedge design randomised controlled trial",
abstract = "Objective To assess whether the implementation of an intrapartum training package (PROMPT (PRactical Obstetric Multi-Professional Training)) across a health service reduced the proportion of term babies born with Apgar score <7 at 5 min (<75mins). Design Stepped-wedge cluster randomised controlled trial. Setting Twelve randomised maternity units with ≥900 births/year in Scotland. Three additional units were included in a supplementary analysis to assess the effect across Scotland. The intervention commenced in March 2014 with follow-up until September 2016. Intervention The PROMPT training package (Second edition), with subsequent unit-level implementation of PROMPT courses for all maternity staff. Main outcome measures The primary outcome was the proportion of term babies with Apgar<75mins. Results 87 204 eligible births (99.2{\%} with an Apgar score), of which 1291 infants had an Apgar<75mins were delivered in the 12 randomised maternity units. Two units did not implement the intervention. The overall Apgar<75mins rate observed in the 12 randomised units was 1.49{\%}, increasing from 1.32{\%} preintervention to 1.59{\%} postintervention. Once adjusted for a secular time trend, the ‘intention-to-treat’ analysis indicated a moderate but non-significant reduction in the rate of term babies with an Apgar scores <75mins following PROMPT training (OR=0.79 95{\%}CI(0.63 to 1.01)). However, some units implemented the intervention earlier than their allocated step, whereas others delayed the intervention. The content and authenticity of the implemented intervention varied widely at unit level. When the actual date of implementation of the intervention in each unit was considered in the analysis, there was no evidence of improvement (OR=1.01 (0.84 to 1.22)). No intervention effect was detected by broadening the analysis to include all 15 large Scottish maternity units. Units with a history of higher rates of Apgar<75mins maintained higher Apgar rates during the study (OR=2.09 (1.28 to 3.41)) compared with units with pre-study rates aligned to the national rate. Conclusions PROMPT training, as implemented, had no effect on the rate of Apgar <75mins in Scotland during the study period. Local implementation at scale was found to be more difficult than anticipated. Further research is required to understand why the positive effects observed in other single-unit studies have not been replicated in Scottish maternity units, and how units can be best supported to locally implement the intervention authentically and effectively. Trial registration number ISRCTN11640515.",
author = "Erik Lenguerrand and Cathy Winter and Dimitrios Siassakos and Graeme MacLennan and Karen Innes and Pauline Lynch and Alan Cameron and Joanna Crofts and Alison McDonald and Kirsty McCormack and Mark Forrest and John Norrie and Siladitya Bhattacharya and Tim Draycott",
note = "The authors thank the CSO for funding the THISTLE study and the staff of the Scottish maternity units for their participation and continued support with the THISTLE Study. We would like to acknowledge the independent members of the Trial Steering Committee for their participation and continued support with the THISTLE Study. We also wish to thank Joannes Kerssens, Lizzie Nicholson, Mark Macartney, Carole Morris and Katrina Smith from eDRIS, ISD for continued support with the data management and Tracey Davidson, Bev Smith, Becky Bruce, Maria Ntessalen and Gladys McPherson based at CHaRT, University of Aberdeen for their logistic support. Finally, we would like to thank Dr Perla Marang van de Mheen for her insightful contribution in the interpretation of our results. Data availability statement The study data are saved on the National Services Scotland Safe Haven, only accessible by ISD trained and approved member and will be archived as per ISD regulations. Further information on how to access these data and use the Safe Haven are available here: http://www.isdscotland.org/Products-and-Services/EDRIS/. Funding The article outlines independent research funded by the Chief Scientist Office (CZH/4/893).",
year = "2019",
month = "7",
day = "13",
doi = "10.1136/bmjqs-2018-008625",
language = "English",
journal = "BMJ Quality & Safety",
issn = "2044-5415",
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TY - JOUR

T1 - Effect of hands-on interprofessional simulation training for local emergencies in Scotland

T2 - the THISTLE stepped-wedge design randomised controlled trial

AU - Lenguerrand, Erik

AU - Winter, Cathy

AU - Siassakos, Dimitrios

AU - MacLennan, Graeme

AU - Innes, Karen

AU - Lynch, Pauline

AU - Cameron, Alan

AU - Crofts, Joanna

AU - McDonald, Alison

AU - McCormack, Kirsty

AU - Forrest, Mark

AU - Norrie, John

AU - Bhattacharya, Siladitya

AU - Draycott, Tim

N1 - The authors thank the CSO for funding the THISTLE study and the staff of the Scottish maternity units for their participation and continued support with the THISTLE Study. We would like to acknowledge the independent members of the Trial Steering Committee for their participation and continued support with the THISTLE Study. We also wish to thank Joannes Kerssens, Lizzie Nicholson, Mark Macartney, Carole Morris and Katrina Smith from eDRIS, ISD for continued support with the data management and Tracey Davidson, Bev Smith, Becky Bruce, Maria Ntessalen and Gladys McPherson based at CHaRT, University of Aberdeen for their logistic support. Finally, we would like to thank Dr Perla Marang van de Mheen for her insightful contribution in the interpretation of our results. Data availability statement The study data are saved on the National Services Scotland Safe Haven, only accessible by ISD trained and approved member and will be archived as per ISD regulations. Further information on how to access these data and use the Safe Haven are available here: http://www.isdscotland.org/Products-and-Services/EDRIS/. Funding The article outlines independent research funded by the Chief Scientist Office (CZH/4/893).

PY - 2019/7/13

Y1 - 2019/7/13

N2 - Objective To assess whether the implementation of an intrapartum training package (PROMPT (PRactical Obstetric Multi-Professional Training)) across a health service reduced the proportion of term babies born with Apgar score <7 at 5 min (<75mins). Design Stepped-wedge cluster randomised controlled trial. Setting Twelve randomised maternity units with ≥900 births/year in Scotland. Three additional units were included in a supplementary analysis to assess the effect across Scotland. The intervention commenced in March 2014 with follow-up until September 2016. Intervention The PROMPT training package (Second edition), with subsequent unit-level implementation of PROMPT courses for all maternity staff. Main outcome measures The primary outcome was the proportion of term babies with Apgar<75mins. Results 87 204 eligible births (99.2% with an Apgar score), of which 1291 infants had an Apgar<75mins were delivered in the 12 randomised maternity units. Two units did not implement the intervention. The overall Apgar<75mins rate observed in the 12 randomised units was 1.49%, increasing from 1.32% preintervention to 1.59% postintervention. Once adjusted for a secular time trend, the ‘intention-to-treat’ analysis indicated a moderate but non-significant reduction in the rate of term babies with an Apgar scores <75mins following PROMPT training (OR=0.79 95%CI(0.63 to 1.01)). However, some units implemented the intervention earlier than their allocated step, whereas others delayed the intervention. The content and authenticity of the implemented intervention varied widely at unit level. When the actual date of implementation of the intervention in each unit was considered in the analysis, there was no evidence of improvement (OR=1.01 (0.84 to 1.22)). No intervention effect was detected by broadening the analysis to include all 15 large Scottish maternity units. Units with a history of higher rates of Apgar<75mins maintained higher Apgar rates during the study (OR=2.09 (1.28 to 3.41)) compared with units with pre-study rates aligned to the national rate. Conclusions PROMPT training, as implemented, had no effect on the rate of Apgar <75mins in Scotland during the study period. Local implementation at scale was found to be more difficult than anticipated. Further research is required to understand why the positive effects observed in other single-unit studies have not been replicated in Scottish maternity units, and how units can be best supported to locally implement the intervention authentically and effectively. Trial registration number ISRCTN11640515.

AB - Objective To assess whether the implementation of an intrapartum training package (PROMPT (PRactical Obstetric Multi-Professional Training)) across a health service reduced the proportion of term babies born with Apgar score <7 at 5 min (<75mins). Design Stepped-wedge cluster randomised controlled trial. Setting Twelve randomised maternity units with ≥900 births/year in Scotland. Three additional units were included in a supplementary analysis to assess the effect across Scotland. The intervention commenced in March 2014 with follow-up until September 2016. Intervention The PROMPT training package (Second edition), with subsequent unit-level implementation of PROMPT courses for all maternity staff. Main outcome measures The primary outcome was the proportion of term babies with Apgar<75mins. Results 87 204 eligible births (99.2% with an Apgar score), of which 1291 infants had an Apgar<75mins were delivered in the 12 randomised maternity units. Two units did not implement the intervention. The overall Apgar<75mins rate observed in the 12 randomised units was 1.49%, increasing from 1.32% preintervention to 1.59% postintervention. Once adjusted for a secular time trend, the ‘intention-to-treat’ analysis indicated a moderate but non-significant reduction in the rate of term babies with an Apgar scores <75mins following PROMPT training (OR=0.79 95%CI(0.63 to 1.01)). However, some units implemented the intervention earlier than their allocated step, whereas others delayed the intervention. The content and authenticity of the implemented intervention varied widely at unit level. When the actual date of implementation of the intervention in each unit was considered in the analysis, there was no evidence of improvement (OR=1.01 (0.84 to 1.22)). No intervention effect was detected by broadening the analysis to include all 15 large Scottish maternity units. Units with a history of higher rates of Apgar<75mins maintained higher Apgar rates during the study (OR=2.09 (1.28 to 3.41)) compared with units with pre-study rates aligned to the national rate. Conclusions PROMPT training, as implemented, had no effect on the rate of Apgar <75mins in Scotland during the study period. Local implementation at scale was found to be more difficult than anticipated. Further research is required to understand why the positive effects observed in other single-unit studies have not been replicated in Scottish maternity units, and how units can be best supported to locally implement the intervention authentically and effectively. Trial registration number ISRCTN11640515.

UR - http://www.ncbi.nlm.nih.gov/pubmed/31302601

UR - http://www.mendeley.com/research/effect-handson-interprofessional-simulation-training-local-emergencies-scotland-thistle-steppedwedge

U2 - 10.1136/bmjqs-2018-008625

DO - 10.1136/bmjqs-2018-008625

M3 - Article

JO - BMJ Quality & Safety

JF - BMJ Quality & Safety

SN - 2044-5415

ER -