PROMPT stands for Practical Obstetric Multi-Professional Training, a program initially introduced to North Bristol NHS Trust in UK which utilizes clinical simulation and is now practiced to great success all around the world. The aim of the PROMPT Maternity Foundation is to reduce preventable harm for mothers and their babies. Today we take a look at PROMPT’s simulated training program for OB Teams, which we first learned about at ASPIH 2018.
The PROMPT Maternity Foundation provides a multi-professional training program which was initially introduced to North Bristol NHS Trust. It has been shown to improve outcomes for real women and their babies. The introduction of PROMPT training at Southmead Hospital has resulted in:
- 50% reduced hypoxic brain injury
- 45% reduced school-aged cerebral palsy
- 100% reduced permanent brachial plexus injury
- 40% quicker delivery at emergency caesarean section
- 91% reduced litigation costs at North Bristol Trust, UK
PROMPT training is based on the following principles: train 100% of the maternity team, train in multi-professional groups, repeat the training annually. Effective team-working is central to improving clinical outcomes, through improving: communication, team roles and leadership situational awareness.
PROMPT medical simulation scenarios are designed to take place in the clinical area, thereby replicating the environment, equipment and challenges that occur when real emergencies occur. They encourage the use of patient actors to emphasize communication skills; and low-tech, cost-effective but realistic props to support the learning needs without unnecessary expense. Their scenarios concentrate on team-working skills as well as clinical skills, giving clinical staff a deeper understanding of why teams perform the way they do rather than just how they perform.
At our Association for Simulated Practice in Healthcare (ASPIH) 2018 UK recap, Professor Dr. Tim Draycott gave an in-depth presentation about PROMPT sharing greater details about the OB simulated training porgram and its powerful outcomes. Whereas many other published training interventions have not led to an improvement in clinical outcomes, he shared that in Bristol the introduction of PROMPT has led to a 50% reduced Hypoxic Brain Injuries, 45% reduced school-aged cerebral palsy, 100% reduced permanent brachial plexus injuries and 40% quicker deliver at emergency caesarean sections.
And in Kansas, Dr. Draycott shared that the introduction of PROMPT has led to a 30% reduced Apgar <7 at 5 minutes and 100% reduced permanent brachial plexus injury. The introduction of PROMPT has also led to a 91% reduced litigation costs at North Bristol Trust, UK and $38 million saved in litigation in 8 years in Kansas. He called for simulation in maternity teams to go beyond a knowledge transfer to actual practice, both in skills based behavioral communication, as well as using simulation to better understand where we could improve as a research tool.
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 recognized 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.
Internationally, interest has grown and PROMPT training has been adopted in a number of countries outside of the UK. Many of these countries have conducted their own research trials and have demonstrated similar results to those achieved at Southmead Hospital, including: USA, Australia, Zimbabwe, and the Philippines.
