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In 1999, the Institute of Medicine estimated that medical errors accounted for up to 98,000 deaths each year in the United States,1 with the Joint Commission reporting that over 70% of adverse obstetric outcomes were due to failures in teamwork and communication.2 In 2001, the Beth Israel Deaconess Medical Center (BIDMC) Department of Obstetrics and Gynecology teamed up with the Department of Defense and the Risk Management Foundation to develop a Crew Management Resource (CMR) team-based training curriculum in Obstetrics. The Labor and Delivery Unit was the first in obstetrics and one of the first in healthcare to apply CMR to clinical medicine. When BIDMC later reviewed its own Adverse Outcome Index (AOI) and Weighted Adverse Outcome Score (WAOS) data prior to this new CMR curriculum and training (from 1999 to 2001) and after CRM implementation (from 2003 to 2006), they found a 23% decrease in AOI and a 33.2% decrease in WAOS. That translates to 300 fewer women who experienced adverse events after CMR team training was implemented.3

One important prong of CRM team training is the creation of a Rapid Response Team, titled the Contingency Team at BIDMC, which is an organized team that is dedicated to responding to emergency obstetric situations, primarily STAT cesarean deliveries. The care of a parturient in distress may be compromised secondary to overcrowding and lack of organization of a dedicated team caring for the patient. The Contingency Team is a designated group that would be contacted immediately when medical issues develop, so that a plan of action can be developed with all members of the care team involved in the plan, with roles clearly demarcated and specific jobs assigned. Additional staff may be required to assist for a brief period but would be released once emergency has resolved.

Based on the Contingency Team model, all staff members in the Labor and Delivery Unit receive team training through simulations and training modules that are repeated at regular intervals. Drills of obstetric emergencies can be conducted on site in labor and delivery unit to help cement key concepts and familiarize staff with their roles. After a critical event, the team debriefs to review what worked well and what did not (Chapter 33, “Principles of Debriefing”).

The effectiveness of the Contingency Team model is based on the fundamental concepts of team-based approach: Communication, Situation Monitoring, Mutual Support, and Leadership to improve the patient safety.4,5


  • Improve communication and improve patient outcomes.

  • Allow identification and prevention of errors.

  • Shorten decision to delivery interval (DDI).


  • Nurses are assigned at the start of each shift for the Contingency Team roles. (See Table 27-1.)

  • Specific staff are designated to respond to an emergency; nonassigned staff do not respond to prevent overcrowding and maintain appropriate care levels ...

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