Improving communication and cooperation between obstetrical professionals in the Netherlands

The obstetrical care system in the Netherlands is performing suboptimal. Building on the same level of scientific knowledge, other Western-European countries have lower perinatal mortality rates. The objective of this research project is to improve perinatal outcomes by improving the quality of the referral process as well as the collaboration between professionals involved in the chain of obstetrical care. Moreover, a multidisciplinary team training aimed at the implementation of structured referral procedures will be developed and tested.


The research design is a longitudinal multicentre one, using continuous measurements of the primary outcomes and pre- and post-intervention measurements for other outcome measurements (see information above). The effects of the multidisciplinary team training will impact the organisation of obstetrical care at different levels. Therefore, Kirkpatrick's framework was adopted to measure outcomes at the level of the participants in the intervention, changes in attitudes, knowledge, and skills, changes in behaviour, and changes in patient outcomes and organisational practice. The start of the study is January 2013, the first multidisciplinary team training sessions for LOCs will be held in October 2013, the follow-up period will extend until June 2016.

We hypothesize that multidisciplinary team training, to support implementation of a structured referral between obstetrical professionals, will result in better collaboration and thereby to a decrease in adverse perinatal outcomes

The intervention period, including the implementation and follow-up phase, takes 24 months for each LOC. For each LOC, five measurement periods are planned



Pre intervention: SAQ, IPCMS and patient satisfaction after intrapartum referral [timepoint: 3 months]

Post intervention: evaluation questionnaire [6 months], Vignettes study [ 6 / 24 months], Monitoring communication during referrals and measuring patient satisfaction after intrapartum referral [ 8 / 12 / 24 months], SAQ and IPCMS [ 12 / 24 months]



Continues data; Perinatal and maternal morbidity and mortality rates

Five LOCs participate in the study intervention using a stepped wedge design. The intervention is a stepwise implementation programme of the SBAR (Situation - Background - Assessment - Recommendation) tool for structured referrals, using a multifaceted implementation strategy. A crucial part of the implementation strategy is a multidisciplinary team training based on crew resource management principles. The intervention period, including the implementation and follow-up phase, takes 24 months for each LOC. At 3-month time intervals a new LOC starts with the intervention.