Pregnancy and Childbirth Anaesthesia
Conditions
Interventions
Low dose high frequency booster training
High dose low frequency booster training
Sponsors
Vanderbilt University Medical Center
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: District hospitals in Kenya will be randomized to have healthcare workers at each site either receive low dose, high frequency (LDHF) booster training approach or a high dose, low frequency (HDLF) approach. District-level hospitals (not tertiary) with at least one anesthesia provider performing greater than 30 Caesarean deliveries (CD) per month that have not undergone previous simulation training for obstetric emergencies will be approached for study inclusion. All course participants at participating hospitals will be included in the study.
Exclusion criteria
Exclusion criteria: Hospitals will be excluded for not consenting to undergo initial and follow-up training and data collection according to the research protocol.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Percentage of Checklist Items Completed on Safe C/S Team Checklist The Safe C-Section Team Checklist (Figure 2) includes critical preparation and management actions for elective, urgent and emergent CD including specific actions for postpartum hemorrhage, pre-eclampsia/eclampsia, and obstructed labor/fetal distress, which are leading causes of maternal mortality in sub-Saharan Africa. Research assistants blinded to the intervention group will be recruited and trained to observe CD at training sites for two weeks prior to the initial MOST session, two weeks immediately following the initial MOST session, and 12 months later. If adequate funding allows, additional observations will be made at 3, 6, and 9-months. Observers will rate clinical performance of the obstetric team according to compliance with action items on the Safe C-Section Team Checklist prior to and during actual CD with the primary outcome defined as % Safe C-Section team checklist items completed. Checklists are currently being used in this setting to assess team performance by team members, but collection of this data by observers is not done routinely. Observers affiliated with the research study are covered by the local Kijabe IRB for performing this process. Preliminary study has shown that in district facilities, 10-20 consecutive clinical observations are possible during a two-week window. Of note, because of the small size of the target facilities it is assumed that some members of the CD team will have been training participants and scoring will reflect team, and not individual, performance. Data on participation with initial MOST training will be recorded during observations. | — |
Secondary
| Measure | Time frame |
|---|---|
| Effect of Intervention on Third Delay (Delay in Receiving Definitive Care) and Patient Outcomes In addition to clinical performance, observers will document time of patient arrival to the hospital, time of decision to proceed to CD, time from arrival to OR and delivery of the neonate, 1 and 5-minute APGAR score and immediate and 24-hour survival of neonate and mother. The first delay is the delay in the decision to access health care. The second is the delay in reaching a healthcare facility that can provide care. The third delay (delay in receiving definitive care once at the facility) can likely be impacted by this training and we will evaluate whether sustained change is dependent upon the mode of education. Associations between proportion of checklist compliance and patient outcome will also be assessed. | — |
Countries
Kenya
Contacts
Public ContactJames Kynes
Assistant Professor
Outcome results
None listed