Research There is increasing evidence that the PROMPT method of training for maternity emergencies has a significant clinical impact, not only in the UK, but internationally. In 2016 PROMPT training was recognised in the NHS England National Maternity Review, Better Births. The growth and increasing recognition of PROMPT training is underpinned by robust research, collecting further evidence to support the improvements in outcomes seen in some maternity units in the UK and across the globe. PROMPT Maternity Foundation (PMF) research projects are funded through fundraising, corporate partnerships and research grants from both UK and international bodies. The THISTLE StudyPMF received a grant from the Chief Scientist’s Office in Scotland to undertake a stepped-wedge study of PROMPT implementation in all maternity units in Scotland. The 12 units which attended the Train-The-Trainers (T3) programme in 2015 are all running local PROMPT courses in their own units. This study will analyse key maternity outcomes from each maternity unit, both before and after the training to enable to ascertain where there has been any significant change in each unit’s outcomes. Collection of the data continues to be ongoing and PMF are awaiting the results. THISTLE-PlusThe THISTLE-Plus Study is a qualitative study funded by the Health Foundation and is being run in parallel with the wider THISTLE Study, as well as being a collaboration between clinical researchers from PMF and qualitative researchers from the University of Bristol. THISTLE-Plus is an in-depth process evaluation of the implementation of PROMPT, investigating the facilitators and inhibitors to the introduction of training. The principal aim of the study has been to identify and explore the factors affecting the implementation of PROMPT, in order to inform efforts to improve its delivery at scale and across different contexts. The study involved 4 Scottish maternity units and employed a mixed-method approach to data collection which took place in 2016. A total of 10 focus group discussions and 8 semi-structured interviews were conducted with local PROMPT trainers and multi-professional staff across 4 Scottish maternity units with 4 local PROMPT training days observed. In addition, 350 maternity staff completed Safety Attitude Questionnaires to measure local workplace culture. Data analysis is currently nearing completion, this has involved statistical analysis, coding of the interview and focus group transcripts, to develop a thematic framework to describe and explain the factors affecting implementation of PROMPT training. The study findings are due to be published in late 2017. Health economics of obstetric emergency trainingPMF Research Fellow, Dr Chris Yau, has been researching the health economics of obstetric emergency training. His micro-cost analysis of setting up and running PROMPT for one year at Southmead Hospital has now been published in an international, peer-reviewed journal. The abstract for this can be found on this link: https://www.ncbi.nlm.nih.gov/pubmed/27496301 Erbs Palsy quality of life studyDr Chris Yau has worked closely with the Erbs Palsy Group , a UK-based charity, to investigate the quality of life associated with obstetric brachial plexus injuries. They have been assessing the quality of life of adults with obstetric brachial plexus injuries, but have also been interested in the quality of life of carers, looking after children suffering from this injury. Data collection for this project is still ongoing and this work will inform the health economics work that Chris is planning with University College, London. Money no-one wants to receive, or pay: A collaboration between insurers and maternity services to improve outcomes and reduce litigation costs.Dr Chris Yau has been involved in a Health Foundation funded study exploring the roles of the insurers and different models of clinical-insurer engagement. Chris has been collaborating with senior law lecturer, Dr Oliver Quick, from the University of Bristol and between them they have interviewed key members from the state insurers in England, Wales, Scotland, Republic of Ireland, Sweden and Victoria, Australia. In March 2017, Chris and Oliver organised a symposium to discuss the findings and emerging themes from the project. Senior representatives from all participating insurers attended the event with plans to reconvene later in the year. Chris will be working with the state insurer in Sweden to investigate potential maternity litigation indicators. This will build on the Department of Health work Chris participated in during 2017.Chris has also completed a project of Provision of Data Analysis and Economic Evaluation of the Incentivisation Scheme in support of Sign up to Safety on behalf of NHS Litigation Authority (now known as NHS Resolution) and in collaboration with University College London (UCL). The Odón DevicePMF have been awarded a grant from Becton Dickinson (BD), a medical device company commissioned by the World Health Organisation (WHO) to develop the Odón Device. Dr Stephen O’Brien, Research Fellow, is the lead researcher, supervised by Dr Jo Crofts. The Odón device is an instrument designed by an Argentinian engineer, Jorge Odón, and is proposed as an alternative method for helping women to give birth, instead of using more traditional devices such as forceps or ventouse, particularly in low resource settings, where these instruments may not be available or where birth attendants are untrained. In 2016, Stephen and Jo, in collaboration with the BD team, conducted simulation studies using pressure-sensing technology and training mannequins developed with Limbs & Things, to assess the performance of the device, comparing it to forceps and ventouse. The team have also conducted a series of Human Factors studies from March 2016 to March 2017 enabling the team to improve and validate the design and instructions of the device. In 2017 the PMF/BD team will be preparing for a randomised clinical trial of the Odón device starting in 2018 and PMF have been requested to develop an Odón Training package. Recent research presentations from the PMF team The Odon Device – Training for successWorld Health Organisation, Geneva, Switzerland, July 2017 The Odon Device – Results of simulation studies and the way forwardThe Bill & Melinda Gates Foundation & Becton, Dickinson & Company – Geneva, Switzerland, April 2017 Understanding the implementation of obstetric emergency training: THE THISTLE-Plus Study(Session prize winner – best oral presentation)Royal College Obstetricians and Gynaecologists, Cape Town, South Africa – March 2017 Clinical-insurer engagement workshopPROMPT Symposium – Bath, March 2017 Lessons for implementation – The Philippines PROMPT ProjectPROMPT Symposium – Bath, March 2017 Making a business case: measuring effect, cost & value of trainingPROMPT Symposium – Bath, March 2017 Champions, context & culture: The challenges faced in delivering effective training togetherRoyal Society of Medicine, London – February 2017 Health Economics – a clinical researcher’s perspectiveSevern Deanery Academic Day – January 2017 One Year of PROMPT in the PhilippinesPhilippines PROMPT Project Meeting, Manila, Philippines – Sept 2016 UK Local Implementation of an Obstetric Emergencies Training ProgrammeYork [NM1] – October 2016 The cost of local, multi-professional obstetrics emergencies trainingHSRUK Symposium, Nottingham – July 2016 Evaluating the implementation of obstetric emergencies training at scale: The THISTLE-Plus StudyHSRUK Symposium, Nottingham – July 2016 Rapid adaptation of an obstetrics emergencies training packageEBCOG, Italy – May 2016 Recent publications from the PROMPT Maternity Foundation team. 2019 Effects of hands-on interprofessional simulation training for local emergencies in Scotland: the THISTLE stepped-edge design randomised controlled trial. Lenguerrand E, Winter C, Siassakos D, Maclennan G, Innes K, Lynch P, Cameron A, Crofts J, McDonald A, Mccormack K, Forrest M, Norrie Bhattacharya S, Draycott T 2018 Associations between early term and late/post term infants and development of epilepsy: A cohort study.Odd D, Glover Williams A, Winter C, Draycott T.PLoS One. 2018 Dec 31;13(12) Skills training for operative vaginal birth.Hotton E, O’Brien S, Draycott TJ.Best Pract Res Clin Obstet Gynaecol. 2018 [epub ahead of print] Obstetric brachial plexus injuries (OBPIs): health-related quality of life in affected adults and parents.Yau CWH, Pizzo E, Prajapati C, Draycott T, Lenguerrand E.Health Qual Life Outcomes. 2018 Nov 15;16(1):212. Associations between birth at, or after, 41 weeks gestation and perinatal encephalopathy: a cohort study.Odd DE, Yau C, Winter C, Draycott T, Rasmussen F.BMJ Paediatr Open. 2018; 2: e000010. A rapid cycle method for local adaptation of an obstetric emergencies training program.Ghag K, Winter C, Bahl R, Lynch M, Bautista N, Ilagan R, Draycott TJ.Int J Gynaecol Obstet. 2018; 141: 393–8. 2017 Hypoxic-ischemic brain injury: Planned delivery before intrapartum events.Odd D, Heep A, Luyt K, Draycott T.J Neonatal Perinatal Med. 2017; 10: 347–53. Pressure and traction on a model fetal head and neck associated with the use of forceps, Kiwi™ ventouse and the BD Odon Device™ in operative vaginal birth: a simulation study.O’Brien SM, Winter C, Burden CA, Boulvain M, Draycott TJ, Crofts JF.BJOG. 2017; 124 Suppl 4: 19–25. Design and development of the BD Odon DeviceTM : a human factors evaluation process.O’Brien SM, Mouser A, Odon JE, Winter C, Draycott TJ, Sumitro T, Alisantoso D, Lim WL, Merialdi M, Stankovic AK, Crofts JF.BJOG. 2017; 124 Suppl 4: 35–43. Fetal head position and perineal distension associated with the use of the BD Odon Device™ in operative vaginal birth: a simulation study.O’Brien SM, Winter C, Burden CA, Boulvain M, Draycott TJ, Crofts JF.BJOG. 2017; 124 Suppl 4: 10-18. From design to adoption: generating evidence for new technology designed to address leading global health needs: A comprehensive clinical evidence generation plan for the BD Odon Device™.BD Odon Device Experts’ Group, Merialdi M.BJOG. 2017; 124 Suppl 4: 7-9. The role of operative vaginal birth in the 21st century and a way forward.Draycott TJ, Di Renzo GC.BJOG. 2017; 124 Suppl 4: 5-6. Significant intraventricular hemorrhage is more likely in very preterm infants born by vaginal delivery: a multi-centre retrospective cohort study.Gamaleldin I, Harding D, Siassakos D, Draycott T, Odd D.J Matern Fetal Neonatal Med. 2017: 1-6. THISTLE: trial of hands-on Interprofessional simulation training for local emergencies: a research protocol for a stepped-wedge clustered randomised controlled trial.Lenguerrand E, Winter C, Innes K, MacLennan G, Siassakos D, Lynch P, Cameron A, Crofts J, McDonald A, McCormack K, Forrest M, Norrie J, Bhattacharya S, Draycott T; Thistle group.BMC Pregnancy Childbirth. 2017; 17: 294. Response to ‘Telling the whole story about simulation-based education’.Yau CWH, Pizzo E, Morris S, Odd DE, Winter C, Draycott TJ.Acta Obstet Gynecol Scand. 2017; 96: 1274. Not all training for obstetric emergencies is equal, or effective.Draycott T.BJOG. 2017; 124: 651. Carbetocin versus oxytocin for prevention of post-partum haemorrhage at caesarean section in the United Kingdom: An economic impact analysis.van der Nelson HA, Draycott T, Siassakos D, Yau CWH, Hatswell AJ.Eur J Obstet Gynecol Reprod Biol. 2017; 210: 286-91. 2016 Identifying Deteriorating Patients Through Multidisciplinary Team Training.Merriel A, van der Nelson H, Merriel S, Bennett J, Donald F, Draycott T, Siassakos D.Am J Med Qual. 2016; 31: 589-95. The cost of local, multi-professional obstetric emergencies training.Yau CW, Pizzo E, Morris S, Odd DE, Winter C, Draycott TJ.Acta Obstet Gynecol Scand. 2016; 95: 1111-9. Prevention of brachial plexus injury-12 years of shoulder dystocia training: an interrupted time-series study.Crofts JF, Lenguerrand E, Bentham GL, Tawfik S, Claireaux HA, Odd D, Fox R, Draycott TJ.BJOG. 2016; 123: 111-8. Multi-professional training for obstetric emergencies in a U.S. hospital over a 7-year interval: an observational study.Weiner CP, Collins L, Bentley S, Dong Y, Satterwhite CL.J Perinatol. 2016; 36: 19-24. 2015 The role of insurers in maternity safety.Draycott T, Sagar R, Hogg S.Best Pract Res Clin Obstet Gynaecol. 2015; 29: 1126-31. Myths and realities of training in obstetric emergencies.Draycott TJ, Collins KJ, Crofts JF, Siassakos D, Winter C, Weiner CP, Donald F.Best Pract Res Clin Obstet Gynaecol. 2015; 29: 1067-76. Onsite training of doctors, midwives and nurses in obstetric emergencies, Zimbabwe.Crofts JF, Mukuli T, Murove BT, Ngwenya S, Mhlanga S, Dube M, Sengurayi E, Winter C, Jordan S, Barnfield S, Wilcox H, Merriel A, Ndlovu S, Sibanda Z, Moyo S, Ndebele W, Draycott TJ, Sibanda T.Bull World Health Organ. 2015; 93: 347-51. Measuring quality of maternity care.Collins KJ, Draycott T.Best Pract Res Clin Obstet Gynaecol. 2015; 29: 1132-8. Modified obstetric early warning scoring systems (MOEWS): validating the diagnostic performance for severe sepsis in women with chorioamnionitis.Edwards SE, Grobman WA, Lappen JR, Winter C, Fox R, Lenguerrand E, Draycott T.Am J Obstet Gynecol. 2015; 212: 536. e1-8. 2014 Adaptation and implementation of local maternity dashboards in a Zimbabwean hospital to drive clinical improvement.Crofts J, Moyo J, Ndebele W, Mhlanga S, Draycott T, Sibanda T.Bull World Health Organ. 2014; 92: 146-52. Analysis of legal claims–informing litigation systems and quality improvement.Fox R, Yelland A, Draycott T.BJOG. 2014; 121: 6-10. Using data and quality monitoring to enhance maternity outcomes: a qualitative study of risk managers’ perspectives.Simms RA, Yelland A, Ping H, Beringer AJ, Draycott TJ, Fox R.BMJ Qual Saf. 2014; 23: 457-64. Multiprofessional team simulation training, based on an obstetric model, can improve teamwork in other areas of health care.van der Nelson HA, Siassakos D, Bennett J, Godfrey M, Spray L, Draycott T, Donald F.Am J Med Qual. 2014; 29: 78-82. Millenium Development Goal 4: Reducing perinatal and neonatal mortality in low-resource settings.Smith AC, Mutangiri W, Fox R, Crofts JF.The Obstetrician and Gynaecologist. 2014; 16: 1-5 Impact of introducing practical obstetric multi-professional training (PROMPT) into maternity units in Victoria, Australia.Shoushtarian M, Barnett M, McMahon F, Ferris J.BJOG. 2014; 121: 1710-8. 5-year experience with PROMPT (PRactical Obstetric Multidisciplinary Training) reveals sustained and progressive improvements in obstetric outcomes at a US hospitalWeiner C, Samuelson L, Collins L, Satterwhite C.Am J Obstet Gynecol. 2014: 210: S40. 2013 What makes maternity teams effective and safe? Lessons from a series of research on teamwork, leadership and team training.Siassakos D, Fox R, Bristowe K, Angouri J, Hambly H, Robson L, Draycott TJ.Acta Obstet Gynecol Scand. 2013; 92: 1239-43. Retention of factual knowledge after practical training for intrapartum emergencies.Crofts JF, Fox R, Draycott TJ, Winter C, Hunt LP, Akande VA.Int J Gynaecol Obstet. 2013; 123: 81-5. Development of maternity dashboards across a UK health region; current practice, continuing problems.Simms RA, Ping H, Yelland A, Beringer AJ, Fox R, Draycott TJ.Eur J Obstet Gynecol Reprod Biol. 2013; 170: 119-24. Simulation: improving patient outcomes.Smith A, Siassakos D, Crofts J, Draycott T.Semin Perinatol. 2013; 37: 151-6. Intrapartum care quality indicators: a systematic approach for achieving consensus.Sibanda T, Fox R, Draycott TJ, Mahmood T, Richmond D, Simms RA.Eur J Obstet Gynecol Reprod Biol. 2013; 166: 23-9. Practical obstetric multi-professional training – PROMPTDraycott TJThe Health Foundation 2012 Teamwork for clinical emergencies: interprofessional focus group analysis and triangulation with simulation.Bristowe K, Siassakos D, Hambly H, Angouri J, Yelland A, Draycott TJ, Fox R.Qual Health Res. 2012; 22: 1383-94. 2011 Medical simulation for professional development–science and practice.Fox R, Walker JJ, Draycott TJ.BJOG. 2011;118 Suppl 3: 1-4. Secondary post-partum haemorrhage: challenges in evidence-based causes and management.Babarinsa IA, Hayman RG, Draycott TJ.Eur J Obstet Gynecol Reprod Biol. 2011; 159: 255-60. Evaluating the impact of simulation on translational patient outcomes.McGaghie WC, Draycott TJ, Dunn WF, Lopez CM, Stefanidis D.Simul Healthc. 2011;6 Suppl: S42-7. Team communication with patient actors: findings from a multisite simulation study.Siassakos D, Bristowe K, Hambly H, Angouri J, Crofts JF, Winter C, Hunt LP, Draycott TJ.Simul Healthc. 2011; 6: 143-9. The use of simulation to teach clinical skills in obstetrics.Cass GK, Crofts JF, Draycott TJ.Semin Perinatol. 2011; 35: 68-73. Improving collaboration in maternity with interprofessional learning.Siassakos D, Marshall L, Draycott T.J Midwifery Womens Health. 2011; 56: 183. Measuring the impact of simulation-based training on patient safety and quality of care: Lessons from maternity.Siassakos D, Draycott T.Resuscitation. 2011; 82: 782 Clinical efficiency in a simulated emergency and relationship to team behaviours: a multisite cross-sectional study.Siassakos D, Bristowe K, Draycott TJ, Angouri J, Hambly H, Winter C, Crofts JF, Hunt LP, Fox R.BJOG. 2011; 118: 596-607. Training to reduce adverse obstetric events with risk of cerebral palsy.Siassakos D, Fox R, Draycott T.Am J Obstet Gynecol. 2011; 204: e15-6. The management of a simulated emergency: better teamwork, better performance.Siassakos D, Fox R, Crofts JF, Hunt LP, Winter C, Draycott TJ.Resuscitation. 2011; 82: 203-6. Attitudes toward safety and teamwork in a maternity unit with embedded team training.Siassakos D, Fox R, Hunt L, Farey J, Laxton C, Winter C, Draycott T.Am J Med Qual. 2011; 26: 132-7. 2010 Exploratory randomized controlled trial of hybrid obstetric simulation training for undergraduate students.Siassakos D, Draycott T, O’Brien K, Kenyon C, Bartlett C, Fox R.Simul Healthc. 2010; 5: 193-8. Quality improvement demands quality measurement.Draycott T, Sibanda T, Laxton C, Winter C, Mahmood T, Fox R.BJOG. 2010; 117: 1571-4. More to teamwork than knowledge, skill and attitude.Siassakos D, Draycott TJ, Crofts JF, Hunt LP, Winter C, Fox R.BJOG. 2010; 117: 1262-9. Carbetocin versus oxytocin for the prevention of postpartum haemorrhage following caesarean section: the results of a double-blind randomised trial.Attilakos G, Psaroudakis D, Ash J, Buchanan R, Winter C, Donald F, Hunt LP, Draycott T.BJOG. 2010; 117: 929-36. 2009 A simple tool to measure patient perceptions of operative birth.Siassakos D, Clark J, Sibanda T, Attilakos G, Jefferys A, Cullen L, Bisson D, Draycott T.BJOG. 2009; 116: 1755-61. Prospective evaluation of a continuous monitoring and quality-improvement system for reducing adverse neonatal outcomes.Sibanda T, Sibanda N, Siassakos D, Sivananthan S, Robinson Z, Winter C, Draycott TJ.Am J Obstet Gynecol. 2009; 201: 480. e1-6. Content analysis of team communication in an obstetric emergency scenario.Siassakos D, Draycott T, Montague I, Harris M.J Obstet Gynaecol. 2009; 29: 499-503. Evaluation of a strategy to improve undergraduate experience in obstetrics and gynaecology.Siassakos D, Timmons C, Hogg F, Epee M, Marshall L, Draycott T.Med Educ. 2009; 43: 669-73. PROMPT education and development: saving mothers’ and babies’ lives in resource poor settings.Sibanda T, Crofts JF, Barnfield S, Siassakos D, Epee MJ, Winter C, Draycott T.BJOG. 2009; 116: 868-9. The active components of effective training in obstetric emergencies.Siassakos D, Crofts JF, Winter C, Weiner CP, Draycott TJ.BJOG. 2009; 116: 1028-32. Retrospective cohort study of diagnosis-delivery interval with umbilical cord prolapse: the effect of team training.Siassakos D, Hasafa Z, Sibanda T, Fox R, Donald F, Winter C, Draycott T.BJOG. 2009; 116: 1089-96. 2008 Observations from 450 shoulder dystocia simulations: lessons for skills training.Crofts JF, Fox R, Ellis D, Winter C, Hinshaw K, Draycott TJ.Obstet Gynecol. 2008; 112: 906-12. Documentation of simulated shoulder dystocia: accurate and complete?Crofts JF, Bartlett C, Ellis D, Fox R, Draycott TJ.BJOG. 2008; 115: 1303-8. Improving neonatal outcome through practical shoulder dystocia training.Draycott TJ, Crofts JF, Ash JP, Wilson LV, Yard E, Sibanda T, Whitelaw A.Obstet Gynecol. 2008; 112: 14-20. Patient-actor perception of care: a comparison of obstetric emergency training using manikins and patient-actors.Crofts JF, Bartlett C, Ellis D, Winter C, Donald F, Hunt LP, Draycott TJ.Qual Saf Health Care. 2008; 17: 20-4. 2007 Management of shoulder dystocia: skill retention 6 and 12 months after training.Crofts JF, Bartlett C, Ellis D, Hunt LP, Fox R, Draycott TJ.Obstet Gynecol. 2007; 110: 1069-74. Change in knowledge of midwives and obstetricians following obstetric emergency training: a randomised controlled trial of local hospital, simulation centre and teamwork training.Crofts JF, Ellis D, Draycott TJ, Winter C, Hunt LP, Akande VA.BJOG. 2007; 114: 1534-41. Pattern and degree of forces applied during simulation of shoulder dystocia.Crofts JF, Ellis D, James M, Hunt LP, Fox R, Draycott TJ.Am J Obstet Gynecol. 2007; 197: 156. e1-6. 2006 Training for shoulder dystocia: a trial of simulation using low-fidelity and high-fidelity mannequins.Crofts JF, Bartlett C, Ellis D, Hunt LP, Fox R, Draycott TJ.Obstet Gynecol. 2006; 108: 1477-85. Does training in obstetric emergencies improve neonatal outcome?Draycott T, Sibanda T, Owen L, Akande V, Winter C, Reading S, Whitelaw A.BJOG. 2006; 113: 177-82.