Video‐assisted team debriefing for real‐life management of major postpartum hemorrhage (DBRIEF trial): an interrupted time series analysis

Abstract

Objectives Viewing video recordings of real‐life events during debriefing sessions can enhance recall, deepen understanding, and create additional learning opportunities for healthcare professionals. At the department level, this study aimed to evaluate whether implementing video‐assisted team debriefings in labor wards improved obstetric teams' clinical management of major postpartum hemorrhage (PPH, blood loss ≥1000 mL).

Methods The DBRIEF trial was an interrupted time series analysis, conducted at two Danish maternity units: one secondary and one tertiary. The study included women who experienced major PPH following vaginal birth across three periods: (1) a “Baseline” period (January 2020–September 2020), (2) an “Assessment‐only” period (October 2020–September 2021), and (3) an “Assessment‐&‐debriefing” period (October 2021–September 2022). In periods 2 and 3, an automatic video recording system captured major PPH events in all delivery rooms. In period 3, these videos were used for video‐assisted team debriefings. At study completion, trained assessors, blinded to date of inclusion, reviewed all video recordings to evaluate teams' clinical performance using the “Team Obstetric Postpartum Hemorrhage” tool (TeamOBS‐PPH) and non‐technical performance using the “Assessment of Obstetric Team Performance” tool (AOTP). Register‐based data on the incidence of major PPH was extracted for all three periods.

Results Comparing the “Assessment‐only” period (N = 214) to the “Assessment‐&‐debriefing” period (N = 202), the clinical performance score of teams increased from 84.8 (95% confidence interval [CI] 83.5–86.2) to 86.9 (95% CI 85.6–88.2) (P = 0.029), and the non‐technical performance score increased from 68.0 (95% CI 66.2–69.9) to 74.3 (95% CI 72.6–76.1) (P < 0.001). The incidence of major PPH was 7.6% in the “Baseline” period, 7.5% in the “Assessment‐only” period, and decreased to 6.7% in the “Assessment‐&‐debriefing” period (P = 0.048).

Conclusion Video‐assisted team debriefings might serve as a valuable tool to improve obstetric teams' management of major PPH.