Abstract：
BACKGROUND: Managing obstetric shoulder dystocia requires swift action using correct maneuvers. However, knowledge of obstetric teams\' performance during management of real-life shoulder dystocia is limited, and the impact of non-technical skills has not been adequately evaluated. We aimed to analyze videos of teams managing real-life shoulder dystocia to identify clinical challenges associated with correct management and particular non-technical skills correlated with high technical performance.
METHODS: We included 17 videos depicting teams managing shoulder dystocia in two Danish delivery wards, where deliveries were initially handled by midwives, and consultants were available for complications. Delivery rooms contained two or three cameras activated by Bluetooth upon obstetrician entry. Videos were captured 5 min before and after activation. Two obstetricians assessed the videos; technical performances were scored as low (0-59), average (60-84), or high (85-100). Two other assessors evaluated non-technical skills using the Global Assessment of Team Performance checklist, scoring 6 (poor) to 30 (excellent). We used a spline regression model to explore associations between these two score sets. Inter-rater agreement was assessed using interclass correlation coefficients.
RESULTS: Interclass correlation coefficients were 0.71 (95% confidence interval 0.23-0.89) and 0.82 (95% confidence interval 0.52-0.94) for clinical and non-technical performances, respectively. Two teams had low technical performance scores; four teams achieved high scores. Teams adhered well to guidelines, demonstrating limited head traction, McRoberts maneuver, and internal rotation maneuvers. Several clinical skills posed challenges, notably recognizing shoulder impaction, applying suprapubic pressure, and discouraging women from pushing. Two non-technical skills were associated with high technical performance: effective patient communication, with teams calming the mother and guiding her collaboration during internal rotational maneuvers, and situation awareness, where teams promptly mobilized all essential personnel (senior midwife, consultant, pediatric team). Team communication, stress management, and task management skills were not associated with high technical performance.
CONCLUSIONS: Videos capturing teams managing real-life shoulder dystocia are an effective tool to reveal challenges with certain technical and non-technical skills. Teams with high technical performance are associated with effective patient communication and situational awareness. Future training should include technical skills and non-technical skills, patient communication, and situation awareness.
METHODS: We included 17 videos depicting teams managing shoulder dystocia in two Danish delivery wards, where deliveries were initially handled by midwives, and consultants were available for complications. Delivery rooms contained two or three cameras activated by Bluetooth upon obstetrician entry. Videos were captured 5 min before and after activation. Two obstetricians assessed the videos; technical performances were scored as low (0-59), average (60-84), or high (85-100). Two other assessors evaluated non-technical skills using the Global Assessment of Team Performance checklist, scoring 6 (poor) to 30 (excellent). We used a spline regression model to explore associations between these two score sets. Inter-rater agreement was assessed using interclass correlation coefficients.
RESULTS: Interclass correlation coefficients were 0.71 (95% confidence interval 0.23-0.89) and 0.82 (95% confidence interval 0.52-0.94) for clinical and non-technical performances, respectively. Two teams had low technical performance scores; four teams achieved high scores. Teams adhered well to guidelines, demonstrating limited head traction, McRoberts maneuver, and internal rotation maneuvers. Several clinical skills posed challenges, notably recognizing shoulder impaction, applying suprapubic pressure, and discouraging women from pushing. Two non-technical skills were associated with high technical performance: effective patient communication, with teams calming the mother and guiding her collaboration during internal rotational maneuvers, and situation awareness, where teams promptly mobilized all essential personnel (senior midwife, consultant, pediatric team). Team communication, stress management, and task management skills were not associated with high technical performance.
CONCLUSIONS: Videos capturing teams managing real-life shoulder dystocia are an effective tool to reveal challenges with certain technical and non-technical skills. Teams with high technical performance are associated with effective patient communication and situational awareness. Future training should include technical skills and non-technical skills, patient communication, and situation awareness.
摘要：
背景：管理产科肩难产需要使用正确的动作迅速采取行动。然而,产科团队的知识在现实生活中的肩难产管理过程中的表现是有限的，非技术技能的影响尚未得到充分评估。我们旨在分析管理现实生活中的肩难产的团队的视频，以确定与正确管理相关的临床挑战以及与高技术表现相关的特定非技术技能。
方法：我们收录了17个视频，描述了两个丹麦产房管理肩难产的团队，分娩最初是由助产士处理的，并为并发症提供顾问。产房包含两个或三个摄像头，在产科医生进入时通过蓝牙激活。在激活之前和之后5分钟捕获视频。两名产科医生评估了视频；技术表现得分较低（0-59），平均（60-84），或高（85-100）。另外两名评估员使用全球团队绩效评估清单评估了非技术技能，得6分(差)至30分(优)。我们使用样条回归模型来探索这两个分数集之间的关联。使用类间相关系数评估评分者之间的一致性。
结果：临床和非技术表现的类间相关系数分别为0.71（95％置信区间0.23-0.89）和0.82（95％置信区间0.52-0.94），分别。两支球队的技术表现得分较低；四支球队获得了高分。团队很好地遵守了指导方针，表现出有限的头部牵引力，麦克罗伯茨机动,和内部旋转机动。几种临床技能带来了挑战，特别是识别肩部撞击，施加耻骨上压力，阻止女性推挤。两种非技术技能与高技术性能相关：有效的患者沟通，团队让母亲平静下来，并在内部旋转演习中指导她的合作，和情境意识，小组迅速动员所有必要人员(高级助产士，顾问,儿科团队)。团队沟通,压力管理，任务管理技能与高技术性能无关。
结论：捕获管理现实生活中的肩难产团队的视频是揭示某些技术和非技术技能挑战的有效工具。具有高技术表现的团队与有效的患者沟通和情境意识相关。未来的培训应包括技术技能和非技术技能,患者沟通,和情境意识。
方法：我们收录了17个视频，描述了两个丹麦产房管理肩难产的团队，分娩最初是由助产士处理的，并为并发症提供顾问。产房包含两个或三个摄像头，在产科医生进入时通过蓝牙激活。在激活之前和之后5分钟捕获视频。两名产科医生评估了视频；技术表现得分较低（0-59），平均（60-84），或高（85-100）。另外两名评估员使用全球团队绩效评估清单评估了非技术技能，得6分(差)至30分(优)。我们使用样条回归模型来探索这两个分数集之间的关联。使用类间相关系数评估评分者之间的一致性。
结果：临床和非技术表现的类间相关系数分别为0.71（95％置信区间0.23-0.89）和0.82（95％置信区间0.52-0.94），分别。两支球队的技术表现得分较低；四支球队获得了高分。团队很好地遵守了指导方针，表现出有限的头部牵引力，麦克罗伯茨机动,和内部旋转机动。几种临床技能带来了挑战，特别是识别肩部撞击，施加耻骨上压力，阻止女性推挤。两种非技术技能与高技术性能相关：有效的患者沟通，团队让母亲平静下来，并在内部旋转演习中指导她的合作，和情境意识，小组迅速动员所有必要人员(高级助产士，顾问,儿科团队)。团队沟通,压力管理，任务管理技能与高技术性能无关。
结论：捕获管理现实生活中的肩难产团队的视频是揭示某些技术和非技术技能挑战的有效工具。具有高技术表现的团队与有效的患者沟通和情境意识相关。未来的培训应包括技术技能和非技术技能,患者沟通,和情境意识。
