Résumé
Objectifs
Décrire la mise en oeuvre du programme AMPROOB (Approche multidisciplinaire en prévention des risques obstétricaux) ainsi que son impact sur les résultats cliniques, médicoéconomiques et la satisfaction des professionnels de santé (PS) formés.
Le programme
D’une durée de trois ans, il est centré sur l’apprentissage collectif, la communication, le travail d’équipe et sur l’analyse multidisciplinaire des pratiques. Au Canada, différentes cohortes d’hôpitaux ont été suivies à long terme, et l’impact du programme a été apprécié à l’aide de comparaisons avant/après à partir du taux de morbidité maternelle et néonatale grave, des dépenses liées aux réclamations et de la perception des conditions de travail.
Résultats
En Alberta, une réduction significative de la morbidité néonatale grave (OR: 0,82, IC 95 %: 0,69 à 0,97) et des lacérations périnéales du troisième ou quatrième degré (OR: 0,76, IC 95 %: 0,64 à 0,92) a été observée. En Ontario, au niveau de l’assurance responsabilité hospitalière, une réduction des dépenses d’indemnisation a été mise en évidence. Le stress était diminué pour 68 % des PS formés.
Conclusion
En établissant une nouvelle culture de sécurité des patients, ce programme a été associé à une réduction de la morbidité maternelle et néonatale grave ainsi que des dépenses associées.
Abstract
Objectives
To describe the implementation of the Managing Obstetrical Risk Efficiently (MOREOB) program and its impact on clinical outcomes and satisfaction of health care professionals.
The program
Of 3 years duration, it is focused on collective learning, communication, teamwork and the multidisciplinary analysis of practices. In Canada, several hospital cohorts have been followed for the long term and the impact of the program was analyzed with a before/after method in terms of maternal and neonatal severe morbidity, claims-related expenses and the perception of working condition.
Results
In Alberta, a significant reduction of 3rd or 4th degree perineal tears (OR: 0.76, CI 95%: 0.64 to 0.92) and of serious neonatal morbidity (OR: 0.82, CI 95%: 0.69 to 0.97) was observed. In Ontario, at the level of hospital liability insurance, a reduction in compensation costs was highlighted. The stress was reduced for 68% of health care professionals.
Conclusion
By establishing a new culture of patient safety, this program was associated with a reduction of severe maternal and neonatal morbidity and the costs associated with it.
Références
Kohn LT, Corrigan JM, Donaldson MS (1999) To Err is Human: Building a Safer Health System. Committee on Quality in America, Institute of Medicine. National Academy Press, Washington, DC
Baker GR, Norton PG, Flintoft V, et al (2004) The Canadian adverse events study: the incidence of adverse events among hospital patients in Canada. JAMC 170:1678–1686
Espin S, Lingard L, Baker GR, Regehr G (2006) Persistence of unsafe practice in everyday work: an exploration of organizational and psychological factors constraining safety in the operating room. Qual Saf Health Care 15:165–170
Cour des comptes. Rapport public annuel 2006, La politique de périnatalité, pp 367–396
Cour des comptes. Rapport public annuel 2012, www.ccomptes.fr
http://www.ihi.org/knowledge/Pages/AudioandVideo/WIHIHighlyReliableHospitals.aspx consulté le 8 mai 2012
Amalberti R, Auroy Y, Beerwick DM, Barach P (2005) Five system barriers to achieving ultrasafe health care. Ann Intern Med 142:756–764
JCAHO (2004) Preventing infant death and injury during delivery. Sentinel Event Alert (issue 30). Disponible sur le site http://www.jointcommission.org/assets/1/18/SEA_30.PDF
American Society for Healthcare Risk Management (ASHRM. Réimprimé avec permission). Disponible sur le site http://www.ashrm.org/
Parboosingh IJ (2002) Physician communities of practice: where learning and practice are inseparable. J Cont Educ Health Prof 22:230–236
Nguyen XT, Philip J, Wanke MI, et al (2010) Outcomes of the Introduction of the MOREOB Continuing Education Program in Alberta. J Obstet Gynaecol Can 32:749–755
Healthcare Insurance Reciprocal of Canada (HIROC) http://www.hiroc.com/Home.aspx
Milne K, Bendaly N, Bendaly L, et al (2010) A measurement tool to assess culture change regarding patient safety in hospital obstetrical units. J Obstet Gynaecol Can 32:590–597
Corporation Salus Global, Ref. # JD-1330615: d’après les données recueillies auprès de 66 hôpitaux et huit maisons de naissance du Québec, programme AMPROOB
Corporation Salus Global (2008) Ref. MOREOB: Learning and performance impact. Program evaluation findings
Braunholtz DA, Edwards SJ, Lilford RJ (2001) Are randomized clinical trials good for us (in the short term)? Evidence for a “trial effect”. J Clin Epidemiol 54:217–224
Timmel J, Kent PS, Holzmueller CG, et al (2010) Impact of the Comprehensive Unit-Based Safety Program (CUSP) on safety culture in a surgical inpatient unit. Jt Comm J Qual Patient Saf 36:252–260
Singer SJ, Gaba DM, Falwell A, et al (2009) Patient safety climate in 92 US hospitals: differences by work area and discipline. Med Care 47:23–31
Huang DT, Clermont G, Sexton JB, et al (2007) Perceptions of safety culture vary across the intensive care units of a single institution. Crit Care Med 35:165–176
Sexton JB, Holzmueller CG, Pronovost PJ, et al (2006) Variation in caregiver perceptions of teamwork climate in labor and delivery units. J Perinatol 26:463–470
Nielson P, Mann S (2008) Team function in obstetrics to reduce errors and improve outcomes. Obstet Gynecol Clin N Am 35:81–95
Deering S, Johnston LC, Colacchio K (2011) Multidisciplinary teamwork and communication training. Semin Perinatol 35:89–96
Rudolph JW, Simon R, Rivard P, et al (2007) Debriefing with good judgment: combining rigorous feedback with genuine inquiry. Anesthesiol Clin 25:361–376
Hamman WR, Beaudin-Seiler BM, Beaubien JM, et al (2009) Using in situ simulation to identify and resolve latent environmental threats to patient safety: case study involving a labor and delivery ward. J Patient Saf 5:184–187
Sullivan TJ (1998) Collaboration: a health care imperative. McGraw-Hill medical, New York, p 6
Lakasing L, Spencer JAD (2002) Care management problems on the labour ward: 5 years’ experience of clinical risk management. J Obstet Gynaecol 22:470–476
Joint Commission. Sentinel event statistics data — Root Causes by Event Type (2004 — Q2 2012) http://www.jointcommission.org/assets/1/18/Root_Causes_Event_Type_2004_2Q2012.pdf
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Gagné, G.P., Goubayon, A. & Dupont, C. La sécurité des soins obstétricaux, une affaire de travail d’équipe ; l’expérience canadienne du programme AMPROOB/MOREOB . Rev. med. perinat. 5, 3–11 (2013). https://doi.org/10.1007/s12611-013-0226-8
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DOI: https://doi.org/10.1007/s12611-013-0226-8
Mots clés
- Sécurité des patients
- Formation professionnelle
- Travail d’équipe
- Communication
- Morbidité maternelle et néonatale grave